Fungsi kognitif penderita kanker payudara yang mendapat kemoterapi adjuvant berbasis antrasiklin

SENDJAJA, Sukendro, dr. Johan Kurnianda, Sp.PD-KHOM

2010 | Tesis | S2 MSPPDS-Ilmu Penyakit Dalam

Penelitian ini bertujuan untuk mengetahui pengaruh kemoterapi ajuvan berbasis antrasiklin pada fungsi kognitif penderita kanker payudara. Penelitian ini merupakan penelitian longitudinal prospektif dengan subyek penderita kanker payudara yang mendapat kemoterapi ajuvan berbasis antrasiklin di bangsal penyakit dalam dan poliklinik TULIP RSUP Dr. Sardjito. Subyek yang memenuhi kriteria inklusi dan eksklusi dinilai fungsi kognitifnya dengan mini-mental state examination (MMSE) sebelum kemoterapi (T0), 3 minggu setelah kemoterapi ajuvan II (T1), 3 minggu setelah kemoterapi ajuvan IV (T2), dan 3 bulan setelah kemoterapi ajuvan IV (T3). Perbedaan rerata skor MMSE dianalisis dengan Wilcoxon-signed rank test dan nilai P<0,05 dianggap bermakna secara statistik. Didapatkan 47 subyek yang memenuhi kriteria penelitian selama periode 1 Oktober 2008 – 31 Oktober 2009. Sebanyak 40 subyek menyelesaikan penelitian dan dianalisis. Rerata usia subyek 47,08±6,65 dengan usia berkisar 27 – 61 tahun. Rerata skor MMSE sebelum kemoterapi (T0) = 29,28±1,20, 3 minggu setelah kemoterapi ajuvan II (T1) = 28,60±1,69, 3 minggu setelah kemoterapi ajuvan IV (T2) = 28,18±1,89, dan 3 bulan setelah kemoterapi ajuvan IV (T3) = 27,85±2,03. Rerata perubahan skor MMSE (ΔT0-T1), (ΔT0-T2), dan (ΔT0-T3) berturut-turut adalah 0,68±0,80, 1,10±1,06, dan 1,43±1,36 dengan P<0,001. Kejadian gangguan kognitif dengan skor MMSE < 24 sebanyak 2,5% dan P=1,0. Kesimpulan penelitian ini didapatkan penurunan skor MMSE yang bermakna dari penderita kanker payudara yang mendapat kemoterapi ajuvan berbasis antrasiklin pada 3 minggu setelah kemoterapi ajuvan II, 3 minggu setelah kemoterapi ajuvan IV dan 3 bulan setelah kemoterapi ajuvan IV dibandingkan dengan sebelum pemberian kemoterapi.

nthracycline-based adjuvant chemotherapy in women with breast carcinoma. The study design was prospective longitudinal study. The breast cancer patients who received anthracycline-based adjuvant chemotherapy were recruited from internal medicine wards and TULIP outpatient department Dr. Sardjito General Hospital Yogyakarta. Subjects eligible with inclusion and exclusion criteria were examined for cognitive function by mini-mental state examination (MMSE) before chemotherapy (T0), 3 weeks after 2nd adjuvant chemotherapy (T1), 3 weeks after 4th adjuvant chemotherapy (T2), and 3 months after 4th adjuvant chemotherapy (T3). The mean difference of MMSE scores were analyzed with Wilcoxon-signed rank test and P<0,05 was considered statistically significant. There were 47 subjects eligible to study criteria in October 1st 2008 – October 31st 2009. Forty subjects finished this study and were analyzed. The mean age was 47,08±6,65 with age ranged from 27 to 61 years old. The mean MMSE scores before chemotherapy (T0), 3 weeks after 2nd adjuvant chemotherapy (T1), 3 weeks after 4th adjuvant chemotherapy (T2), and 3 months after 4th adjuvant chemotherapy (T3) were 29,28±1,20, 28,60±1,69, 28,18±1,89, and 27,85±2,03, respectively. The mean MMSE score changes (ΔT0-T1), (ΔT0-T2), and (ΔT0-T3) were 0,68±0,80, 1,10±1,06, and 1,43±1,36, respectively and P<0,001. The incidence of cognitive impairment with MMSE scores < 24 was 2,5% and P=1,0. In conclusion, there was a significant decline of MMSE score in women with breast carcinoma who received anthracycline-based adjuvant chemotherapy at 3 weeks after 2nd adjuvant chemotherapy, 3 weeks after 4th adjuvant chemotherapy, and 3 months after 4th adjuvant chemotherapy compared with before chemotherapy.

Kata Kunci : Fungsi kognitif, Kanker payudara, Kemoterapi ajuvan, Antrasiklin, Cognitive Function, Breast Cancer, Adjuvant Chemotherapy, Anthracycline