Perbandingan Kejadian Efek Samping Antara Pemberian Kemoterapi Taksan dan Kombinasi Antrasiklin Taksan Pada Penderita Kanker Payudara Di RSUD Kabupaten Temanggung

Satya Prima Kustanto, drh. Retno Murwanti, M.P., Ph.D; Prof. Dr. apt. Agung Endro Nugroho, M.Si

2023 | Tesis | S2 Mag.Farmasi Klinik

Penelitian ini bertujuan  untuk mengetahui gambaran kejadian efek samping obat yang menjalani kemoterapi dengan regimen monoterapi dosetaksel dan kombinasi paklitaksel-epirubisin-fluorourasil, serta penanganan efek samping obat pada pasien kanker payudara di RSUD Kabupaten Temanggung. Metode penelitian menggunakan cohort retrospective study. Cara pengambilan data menggunakan consecutive sampling dengan kriteria inklusi pasien wanita dengan diagnosa kanker payudara usia ? 18 tahun dan menjalani kemoterapi sampai 6 siklus. Penelitian dilakukan selama periode Januari 2018 – Desember 2022 di RSUD Kabupaten Temanggung. Uji chi square dan regresi multivariat dilakukan untuk mengetahui hubungan antar variabel penelitian. Sejumlah 94 pasien yang memenuhi kriteria inklusi penelitian terdiri dari 47 pasien menerima regimen monoterapi dosetaksel dan 47 pasien menerima regimen kombinasi paklitaksel-epirubisin-fluorourasil. Kejadian efek samping tertinggi terjadi pada kelompok kombinasi paklitaksel-epirubisin-fluorourasil dibandingkan dengan kelompok monoterapi dosetaksel. Efek samping non hematologi pada kelompok kombinasi dibandingkan monoterapi yaitu rambut rontok (45,7% vs 31,9%), mual (41,5% vs 8,5%) dan stomatitis (30,9% vs 10,6%). Efek samping hematologi pada kelompok kombinasi dibandingkan monoterapi yaitu leukopenia (27,7% vs 1,1%), neutropenia (13,8% vs 0%), peningkatan SGOT dan SGPT (6,4% vs 0%). Sebelum menjalani kemoterapi pasien mendapatkan premedikasi injeksi ranitidine 25mg/ml, injeksi ondansetrone 4mg/ml, injeksi deksametason 5mg/ml dan injeksi dipenhidramin 10mg/ml. Pasien juga mendapatkan postmedikasi berupa obat oral yaitu sukralfat tablet 500mg/8jam, omeprazole kapsul 20mg/12jam, ondansetrone tablet 4mg/8jam dan MST? (morfin) tablet 10mg tiap malam selama 5 hari setelah menjalani kemoterapi. Penanganan kejadian efek samping diberikan berdasarkan keluhan pasien. Leukopenia, neutropenia, rambut rontok dan perubahan kuku menghitam tidak diberikan terapi karena kejadian efek samping bersifat sementara dan reversible serta akan kembali normal jika kemoterapi telah selesai.

This study aims to determine the incidence of drug side effects undergoing chemotherapy with dosetaxel monotherapy regimen and paclitaxel-epirubicin-fluorouracil combination, as well as the handling of drug side effects in breast cancer patients at Temanggung Regency Hospital. The research method used a retrospective cohort study. The data collection method used consecutive sampling with the inclusion criteria of female patients with a diagnosis of breast cancer aged ? 18 years and undergoing chemotherapy up to 6 cycles. The study was conducted during the period January 2018 - December 2022 at RSUD Kabupaten Temanggung. Chi square and multivariate regression tests were performed to determine the relationship between the study variables. A total of 94 patients who met the study inclusion criteria consisted of 47 patients receiving dosetaxel monotherapy regimen and 47 patients receiving paklitaxel-epirubicin-fluorouracil combination regimen. The highest incidence of adverse events occurred in the paklitaxel-epirubicin-fluorouracil combination group compared to the dosetaxel monotherapy group. Non-hematologic side effects in the combination group compared to monotherapy were hair loss (45.7% vs 31.9%), nausea (41.5% vs 8.5%) and stomatitis (30.9% vs 10.6%). Hematologic side effects in the combination group compared to monotherapy were leukopenia (27.7% vs 1.1%), neutropenia (13.8% vs 0%), increased SGOT and SGPT (6.4% vs 0%). Before undergoing chemotherapy, the patient received premedication of ranitidine injection 25mg/ml, ondansetrone injection 4mg/ml, dexamethasone injection 5mg/ml and diphenhydramine injection 10mg/ml. Patients also received postmedication in the form of oral drugs, namely sucralfate tablets 500mg/8 hours, omeprazole capsules 20mg/12 hours, ondansetrone tablets 4mg/8 hours and MST? (morphine) tablets 10mg every night for 5 days after undergoing chemotherapy. Treatment of adverse events was given based on the patient's symptoms. Leukopenia, neutropenia, hair loss and blackening of nails were not treated because the adverse events were temporary and reversible and would return to normal if chemotherapy was completed.

Kata Kunci : Kanker payudara, efek samping, Antrasiklin, Taksan.