HUBUNGAN KADAR HEMOGLOBIN SEBELUM KEMOTERAPI DENGAN TINGKAT KEPARAHAN GEJALA ORTOSTATIK PASIEN KANKER PAYUDARA YANG MENDAPAT KEMOTERAPI TAXANES

RINA MARLINA HAKIEM, dr.Yudiyanta, Sp.S(K); Dr.dr.Ahmad Asmedi, MKes, Sp.S(K); dr.Susanna Hilda Hutajulu, Ph.D, Sp.PD-KHOM

2017 | Tesis-Spesialis | SP ILMU PENYAKIT SYARAF

Latar belakang: Lebih dari 80% pasien kanker payudara yang diterapi dengan taxanes mengalami chemotherapy-induced peripheral neuropathy (CIPN). Gejala CIPN otonom lebih jarang ditemukan dibandingkan gejala sensoris, namun dapat merusak saraf otonom kardiovaskular yang indikator prognosis negatif terjadinya infark miokard dan stroke. Disfungsi otonom kardiovaskular menyebabkan intoleransi ortostatik yang menyebabkan penurunan kesadaran, pandangan kabur, lightheadedness-dizziness, nyeri kepala, kelelahan, kelemahan, mual dan nyeri abdomen, berkeringat dan gemetaran. Anemia terjadi pada lebih dari 40% pasien kanker dan telah diobservasi pada gangguan otonom kardiovaskular. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar hemoglobin sebelum kemoterapi dan tingkat keparahan gejala ortostatik pada pasien kanker payudara yang mendapat kemoterapi taxanes. Metode: Ini merupakan penelitian cohort retrospective pada pasien kanker payudara yang diterapi di RSUP Dr.Sardjito Yogyakarta. Lima puluh empat subjek yang mendapat kemoterapi taxanes setelah operasi reseksi diinklusi. Data kadar hemoglobin sebelum kemoterapi dicatat dari rekam medis pasien. Tingkat keparahan disfungsi otonom dinilai menggunakan orthostatic grading scale (OGS) dengan skala 1-20. Semua data dianalisis statistik secara komputerisasi. Hasil: Median kadar hemoglobin sebelum kemoterapi adalah 12,5 (8,4-15,0) g/dL. Gejala ortostatik terbanyak yang tercacat adalah kelelahan (74,1%), kelemahan (59,3%) dan dizziness (51,9%). Median skor OGS adalah 4. Tidak didapatkan perbedaan rerata kadar hemoglobin yang signifikan antara kelompok normal, ringan, sedang dan berat (p=0,97), namun diantara subjek yang mengalami gejala ortostatik didapatkan kecenderungan rata-rata kadar hemoglobin yang lebih rendah pada kelompok yang lebih parah (12,31���±1,24; 12,13���±1,61 dan 11,91���±2,07). Analisis korelasi menunjukkan kecenderungan kadar hemoglobin yang lebih rendah pada skor OGS yang lebih tinggi, meskipun signifikansinya belum memenuhi (r = -0,004; p= 0,975). Kesimpulan: Pada penelitian ini didapatkan kecenderungan kadar hemoglobin yang lebih rendah pada tingkat gejala ortostatik yang lebih parah pada pasien kanker payudara yang mendapat kemoterapi taxanes. Kata kunci: taxanes, hemoglobin, disfungsi otonom kardiovaskular, gejala ortostatik.

Background: More than 80% of patients with breast cancer (BC) that are treated with taxanes experience chemotherapy-induced peripheral neuropathy (CIPN). Autonomic symptoms of CIPN is less common than the sensory symptoms. However, it may damage cardiovascular autonomic nerve which serves as a negative prognostic factor for myocardial infarction and stroke. Cardiovascular autonomic dysfunction causes orthostatic intolerance and leads to loss of consciousness, blurred vision, lightheadedness-dizziness, headache, fatigue, weakness, nausea and abdominal pain, sweating and tremor. Anemia occurs in more than 40% of cancer patients and has been observed in patients experiencing cardiovascular autonomic dysfunction. This study aimed to determine correlation between pre-treatment hemoglobin level and the severity of orthostatic symptoms in the local patients with BC. Method: This is a retrospective cohort study on patients with BC treated at Dr.Sardjito Hospital, Yogyakarta, Indonesia. Fifty-four women who received taxane-based chemotherapy after surgical resection were included. Clinical data including hemoglobin level were obtained from the patients�¢ï¿½ï¿½ medical records. The severity of orthostatic symptoms were assessed using an orthostatic grading scale (OGS) questionnaire with scale of 0-20. All data were processed for computerized statistical analysis. Results: The median hemoglobin level prior to chemotherapy was 12.5 (8.4-15.0) g/dL. The most orthostatic symptoms recorded were fatigue (74.1%), weakness (59.3%) and dizziness (51.9%). The median of OGS score was 4. There was no significant difference in the mean hemoglobin level among patients with no, mild, moderate and severe orthostatic symptoms (p= 0.970). However, among subjects with orthostatic symptoms only, there was an average tendency of lower hemoglobin level in the more severe group (12.31���±1.24; 12.13���±1.61 and 11.91���±2.07). Correlative analysis showed a tendency of lower hemoglobin level at the higher OGS level, although significance was not achieved (r = -0.004; p= 0.975). Conclusions: In the local patients with BC receiving taxane-based chemotherapy, we found a tendency of lower hemoglobin level in individuals with more severe orthostatic symptoms.

Kata Kunci : taxanes, hemoglobin, disfungsi otonom kardiovaskular, gejala ortostatik