Rela ionship be ween chemo he apy-induced
ad e se eac ions and heal h- ela ed quali y o li e
in pa ien s wi h b eas cance
Blanca P ie o-Calleje o, PhD
a
, F ancisco Ri e a, PhD
b
, Ja ie Fagundo-Ri e a, MSc, MRes
c
,
Adol o Rome o, PhD
d
, Maca ena Rome o-Ma ín, PhD
e
, Juan Gómez-Salgado, PhD
,g,∗
,
Ca los Ruiz-F u os, PhD
,g
Abs ac
Backg ound and objec i es: Chemo he apy does no only a ec cance cells; i also a ec s, o a g ea e o lesse deg ee, all
o he cells in he body. This oxici y should be assessed acco ding o i s se e i y, equency, and du a ion, aking in o accoun
objec i e and subjec i e dimensions in i s assessmen . This assessmen is a highly ele an aspec when p o iding ca e o
chemo he apy pa ien s, mainly due o he impac o he ea men on he pa ien ’s quali y o li e, as well as he i al isk i may imply
unde ce ain ci cums ances. Fo all his, he objec i e o his s udy was o assess he ela ionship be ween chemo he apy-
associa ed ad e se eac ions and heal h- ela ed quali y o li e in b eas cance pa ien s.
Ma e ials and me hods: Wi h his pu pose, a desc ip i e c oss-sec ional s udy was de eloped on 110 b eas cance pa ien s
who we e ea ed wi h doce axel, epi ubicin, and cyclophosphamide.
Resul s: I is wo h highligh ing he nega i e e ec o nausea, dysgeusia, pe iphe al neu opa hy, loss o appe i e, myalgia, and
pe iphe al edema on he quali y o li e. Likewise, i is wo h men ioning pe iphe al neu opa hy as he oxici y ha a ec s a g ea e
numbe o quali y-o -li e indica o s.
Conclusions: To sum up, i would be necessa y o make heal h p o essionals awa e o he impo ance o chemo he apy-
associa ed ad e se eac ions.
Abb e ia ions: QT =chemo he apy, TEC = ea men scheme consis ing o doce axel, epi ubicin and cyclophosphamide.
Keywo ds: b eas cance , d ug- ela ed side e ec s and ad e se eac ions, heal h- ela ed quali y o li e, pa ien sa e y, quali y o
heal h ca e, oxici ies
1. In oduc ion
Chemo he apy (QT) does no only a ec cance cells; i also
a ec s, o a g ea e o lesse deg ee, all o he cells in he body.
Specifically, he mos a ec ed cells by he cy o oxic e ec o
chemo he apy a e hose ha sha e cha ac e is ics wi h umo
cells, especially high-speed cell di ision, such as hai ollicles,
bone ma ow, diges i e ac cells, and ep oduc i e sys em cells.
The e o e, chemo he apeu ic ea men s ha e a se ies o mo e o
less se ious e ec s on he es o he body: These a e called side
e ec s o ad e se eac ions.
[1]
The Wo ld Heal h O ganiza ion defines an Ad e se D ug
Reac ion as a esponse o a medicine which is noxious and
unin ended, and which occu s a doses no mally used in man
o p ophylaxis, diagnosis, o he apy o disease o o he
modifica ion o physiologic unc ion.
This oxici y should be assessed acco ding o i s se e i y,
equency, and du a ion, aking in o accoun objec i e and
subjec i e dimensions in i s assessmen . The o me include hose
ha can be e alua ed by physical examina ion o labo a o y es s,
while he la e would include hose ha cause symp oms ha a e
no ela ed o e aluable physical signs o analy ical al e a ions,
and hey mus be assessed exclusi ely a he medical consul a ion.
The eason o assessing chemo he apy-associa ed oxici y is
because many o he ad e se eac ions could be a oided o
minimized by pe o ming a ho ough e alua ion a e each
chemo he apy cycle.
[2,3]
The possibili y o a oiding o minimizing
Edi o : Vic o C. Kok.
The au ho s ha e no conflic s o in e es o disclose.
All da a gene a ed o analyzed du ing his s udy a e included in his published
a icle [and i s supplemen a y in o ma ion files].
a
Hospi al Vi gen de la Bella, Lepe, Huel a,
b
Depa men o Expe imen al
Psychology, Facul y o Psychology, Uni e si y o Se ille, Se ille,
c
Depa men o
Heal h and Eme gencies, Spanish Red C oss, Local Commi ee o Se ille,
Doc o al P og amme, Uni e si y o Huel a, Huel a,
d
Uni e si y Hospi al Vi gen de
la Vic o ia, Nu sing and Podia y Depa men , Heal h Sciences School, Uni e si y
o Málaga, Málaga,
e
Nu sing Depa men , Facul y o Nu sing, Uni e si y o
Huel a,
P e en i e Medicine and Public Heal h Uni , Sociology, Social Wo k and
Public Heal h Depa men , Labou Sciences Facul y, Uni e si y o Huel a, Huel a,
Spain,
g
Sa e y and Heal h Pos g adua e P og amme, Uni e sidad Espí i u San o,
Guayaquil, Ecuado .
∗
Co espondence: Juan Gómez-Salgado, Depa men o Sociology, Social Wo k
and Public Heal h, Uni e si y o Huel a. A enida T es de Ma zo, s/n, Huel a
21007, Spain (e-mail: [email p o ec ed]).
Copy igh ©2020 he Au ho (s). Published by Wol e s Kluwe Heal h, Inc.
This is an open access a icle dis ibu ed unde he e ms o he C ea i e
Commons A ibu ion-Non Comme cial License 4.0 (CCBY-NC), whe e i is
pe missible o download, sha e, emix, ans o m, and buildup he wo k p o ided
i is p ope ly ci ed. The wo k canno be used comme cially wi hou pe mission
om he jou nal.
How o ci e his a icle: P ie o-Calleje o B, Ri e a F, Fagundo-Ri e a J, Rome o
A, Rome o-Ma ín M, Gómez-Salgado J, Ruiz-F u os C. Rela ionship be ween
chemo he apy-induced ad e se eac ions and heal h- ela ed quali y o li e in
pa ien s wi h b eas cance . Medicine 2020;99:33(e21695).
Recei ed: 11 Ma ch 2020 / Recei ed in final o m: 30 June 2020 / Accep ed: 6
July 2020
h p://dx.doi.o g/10.1097/MD.0000000000021695
Obse a ional S udy Medicine®
OPEN
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chemo he apy-associa ed oxici y is a highly ele an aspec in
cance pa ien ca e, mainly because o he impac i poses on he
pa ien ’s quali y o li e, as well as he i al isk i can cause unde
some ci cums ances.
[3–6]
Oncologis s gene ally main ain, educe, o delay adminis a-
ion o he nex chemo he apy cycle based on he collec ed
oxici y.
[2]
Unde es ima ion o ad e se eac ions can lead o lack
o dose adjus men s whe e app op ia e and, subsequen ly, he
unadjus ed dose may ep oduce o inc ease he complica ions
expe ienced in he p e ious cycle, leading o inc eased
mo bidi y, a oidable hospi alisa ions, o p ema u e emo al o
chemo he apy.
[3,4,7,8]
In addi ion, pa ien s unde es ima e ad e se eac ions by
conside ing hem as pa o he ea men , and e en as a sign
ha he ea men is “wo king.”
[9–11]
The e o e, as Salsman
e al
[9]
demons a e in a desc ip i e compa a i e s udy, al hough
pa ien s pe cei e hese ad e se eac ions as disabling, hey o en
unde s and hem as a no mal pa o he ea men . Fu he mo e,
pa ien s ha e o wai un il hei nex appoin men o epo any
oxici y episodes, so incidence and in ensi y a e likely o be
subjec ed o memo y biases.
On he con a y, physicians s ongly suppo he need o ea
hese oxici ies and he ele ance o p o essional abili y o he
same pu pose.
[9]
The esul ing unde - egis a ion o equency
and in ensi y con adic s doc o s’belie ha i oxici ies a e a
p oblem, hei pa ien s will in o m hem. In gene al, oncology
heal h wo ke s o en unde es ima e he incidence o chemo-
he apy-associa ed oxici ies.
[3,11,12]
By con as , he holis ic
applica ion o day hospi al nu sing ca e implies a g ea e
knowledge o hese ad e se eac ions.
[13]
Howe e , ad e se eac ions main ained du ing chemo he apy
cycles can imply a majo impac on he quali y o li e o he cance
pa ien by al e ing me abolic balance, dec easing men al
pe o mance, degene a ing sel -ca e and unc ional capaci y,
and e en inc easing he isk o wi hd awal o he chemo he apy
ea men .
[3,10,14,15]
In con as , he e a e ew s udies
[16]
ha link chemo he apy-
associa ed oxici ies wi h he pa ien s’quali y o li e. Mos o
hem a e ela ed o nausea and omi ing, lymphedema, pain, and
symp oms o p ema u e menopause.
[16,17]
Howe e , hey ba ely
collec o he oxici ies, no leas impo an o he pa ien , such as
pe iphe al neu opa hy.
[18]
Fo example, he ea men scheme consis ing o doce axel,
epi ubicin, and cyclophosphamide (TEC) has a o able clinical
ou comes o b eas cance pa ien s.
[19–24]
In con as , his
scheme is highly oxic o he pa ien ’s body, and i is necessa y o
moni o he oxici ies ha occu a e he chemo he apy
cycles.
[25,26]
This con ol would be aimed a educing he dose
a he op imal ime o a oid o e dosing.
Thus, i is impo an o know, collec , and p o ocolize clinical
pe o mance in each o he side e ec s associa ed wi h each ype
o chemo he apy d ug.
The e o e, he objec i e o his s udy was o analyze he
ela ionship be ween chemo he apy-associa ed ad e se eac ions
and he heal h- ela ed quali y o li e o b eas cance pa ien s.
2. Me hods
2.1. Design
Desc ip i e c oss-sec ional s udy. B eas cance pa ien s in
ea men wi h fi s -line neoadju an o adju an chemo he apy
wi h doce axel, epi ubicin and cyclophosphamide we e s udied.
The o al s udy pe iod was be ween May 2012 and Augus 2014,
in a second-le el hospi al (medium le el o complexi y).
2.2. Pa icipan s
The inclusion c i e ia implied all b eas cance pa ien s unde
chemo he apeu ic ea men , being i neoadju an o adju an ,
wi h he TEC egimen+filg as im o pegfilg as im colony
s imula ing ac o + iple an ieme ic he apy wi h dexame ha-
sone, ap epi an , and ondanse on, and who had a leas
unde gone 1 cycle h ough his scheme. All pa ien s who,
mee ing he inclusion c i e ia, had p e iously esponded o he
ques ionnai e de eloped in he s udy, as well as all pa ien s who
we e s a ing hei fi s ea men cycle, we e excluded.
Fo he calcula ion o he equi ed sample size, he o al
numbe o pa ien s wi h hese cha ac e is ics ini ia ing hei
ea men o 1 yea h ough he TEC scheme (app oxima ely 60)
was aken in o accoun , wi h a ep esen a i e sample size o
52 es ima ed pa ien s, a 95% confidence le el, and a maximum
es ima e e o o 5%. Howe e , i was calcula ed ha o es ima e
he di e ences in quali y o li e wi h, a leas , an a e age e ec
size (Cohen d g ea e han o equal o 0.3), based on a 95%
confidence le el, a s a is ical powe o 10%, and an accu acy o
5 poin s, a leas 78 subjec s we e equi ed. Finally, aking in o
accoun a low p opo ion o losses in esponses ( ui o a
p e iously conduc ed pilo s udy), a minimum sample size o
80 pa ien s was es ablished. The ques ionnai e was gi en
andomly, acco ding o a clus e scheme, in 1 o he 6 ea men
cycles so, when homogeneously s a ified by he apy cycles, a
minimum sample o 10/11 subjec s in each o he cycles was
es ima ed.
The final sample consis ed o 112 women wi h b eas cance
who me he es ablished inclusion c i e ia, hus exceeding he
minimum es ablished sample and collec ing, in mos cycles, mo e
han he 10/11 p e iously es ablished pa ien s. All he pa ic-
ipan s comple ed he 6 chemo he apy cycles. Two pa ien s
e en ually declined o pa icipa e in he s udy, so hei da a we e
omi ed, and his esul ed in a final sample o 110 pa ien s.
2.3. Ins umen s
An “ad hoc”ques ionnai e was p epa ed o he pa ien ,
including all common nonhema ological ad e se eac ions
obse ed wi h he TEC scheme in p e ious clinical ials,
[24,27]
as well as he specifica ion shee o each d ug, collec ed in he
Spanish Agency o Medicines and Medical P oduc s. These
oxici ies we e subsequen ly deli e ed, o ex e nal alida ion
using a Delphi echnique, o 11 oncologis s ela ed o b eas
cance o speci y he es ima ed equency o each oxici y. In
addi ion, hey we e asked whe he hey conside ed ha he e was
any o he ad e se eac ion o be aken in o accoun . The esul
was posi i e o he p epa ed ques ionnai e.
To ob ain he e ifica ion o alidi y, he ques ionnai e was
subjec ed o p e ious s udy. To his end, he ques ionnai e was
p o ided o an ini ial sample o 12 b eas cance pa ien s
unde going he TEC scheme and o 5 oncologis s who ea ed
b eas cance o assess, on he one hand, he unde s anding o he
ques ionnai e and, on he o he hand, he comple eness in he
collec ion o he mos common ad e se symp oma ology in his
ype o ea men . The esul s showed he adequacy o he
ques ionnai e o he p oposed pu poses.
P ie o-Calleje o e al. Medicine (2020) 99:33 Medicine
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Fo he assessmen o heal h- ela ed quali y o li e, he
Eu oQol-5D ques ionnai e
[28]
was used o p esen ing an A
le el o ecommenda ion and because i bes sui ed he needs o
he s udy. Se e al s udies suppo ed he alidi y o he EQ-5D-3L
index.
[29–31]
2.4. P ocedu e
Medical p esc ip ions ha e been e iewed daily by loca ing he
pa ien s unde s udy. These pa ien s had o p e-en e he
oncology consul a ion and hen go o he Day Hospi al o
ecei e hei ea men . A day hospi al is a heal h-cen e ed
s uc u e h ough which he pa ien is admi ed o a planned
numbe o hou s du ing which hey ecei e specialized ea men
om he specialis s. These ea men s equi e moni o ing o
medical equipmen ha mus be handled wi hin he medical
p emises. A he end o he ca e, he pa ien e u ns home. Then,
a he Day Hospi al, each pa ien was gi en he ques ionnai e,
ha is, he subjec o s udy, wi h which she esponded o he
oxici ies su e ed in he p e ious 21 days, ha is, in he p e ious
cycle. The ques ionnai e was gi en andomly in 1 o he 6
ea men cycles. The objec i e and how o app op ia ely answe
he ques ions we e explained in de ail. Once comple ed, he
pa ien was excluded o he ollowing cycles. In addi ion, he
help o nu ses was a ailable a all imes o help wi h any doub s
when filling he ques ionnai e. All he pa ien s signed he
in o med consen a e ecei ing in o ma ion on i and all he
possible doub s had been esol ed by he main esea che .
2.5. Da a analysis
Desc ip i e s a is ics, con as es s o p opo ions (x
2
es ) and
means (S uden es and Mann–Whi ney U es ), ag eemen le el
con as (Cohen Kappa), and e ec size assessmen echniques
(Phi, C ame V, and Cohen d) we e used. The s a is ical so wa e
used was IBM SPSS S a is ics 22.0 and EQS 6.2. In all cases, a
s a is ical significance o P<.05 was equi ed.
2.6. E hical aspec s
The s udy was ca ied ou , o he de elopmen and ollow-up o
he clinical esea ch, ollowing he “E hical P inciples o Medical
Resea ch wi h Humans”compiled in he la es e sion o he
Helsinki Decla a ion (Edinbu gh e sion, Oc obe 2000). This
s udy was app o ed by he Resea ch E hics Commi ee o he
p o ince o Huel a on May 2013, wi h esea ch code: PRI-TEC-
2012-01. In all cases, he anonymi y o he pa icipan s was
gua an eed. In addi ion, an in o med w i en consen was
ob ained p io o pa icipa ion, and he esea ch p o ocol
included he app o al o he Huel a Biomedical Resea ch E hics
Commi ee. In addi ion, he basic Law 41/2002 egula ing pa ien
au onomy and igh s and obliga ions in he field o in o ma ion
and clinical documen a ion was implemen ed.
3. Resul s
The final sample consis ed o 110 women. The p ofile o he s udy
pa icipan is a woman wi h an a e age age o 49.61 ( ypical
de ia ion o 8.28 yea s and wi h a ange o age om 29 o 68
yea s), ma ied (78.9%), wi h child en (83.5%), who is usually
accompanied du ing he consul a ion (96.2%). All he pa ien s
comple ed he 6 chemo he apy cycles.
The ype o ecei ed ea men was ela i ely homogeneous
be ween neoadju an (p esu ge y) and adju an (pos su ge y)
ea men , wi h esul s o abou 50%. Specifically, he pe cen age
o pa ien s who we e ecei ing he ea men as a neoadju an
was 44.5%, and 55.5% as adju an . The majo i y o pa ien s
esponded o he ques ionnai e o include he ad e se eac ions
su e ed a e he 21 days ha las ed hei fi s (26.4%) and
second (26.4%) cycle o chemo he apy. The cycle wi h he lowes
esponse a e was he fi h one (8.2%), his being he las da a
collec ion cycle (Table 1).
On he o he hand, 52.3% o pa ien s main ained he same
dose as he one p esc ibed a he beginning o he fi s
chemo he apy cycle. Howe e , in 47.7% o pa ien s, his dose
had o be educed in 20% due o hema ological oxici y
(neu openia) o nonhema ological oxici y (pe iphe al neu opa-
hy, dia hoea, e c). Specifically, 62.5% o pa ien s s a ed hei
second chemo he apy cycle wi h a educed dose.
Likewise, 66.4% o pa ien s did no a end an eme gency
depa men du ing he whole p ocess. Howe e , 33.6% o hose
a ending he eme gency depa men we e e en ually admi ed o
hospi al o an a e age o 3 days. 56.7% we e admi ed due o
oxici ies su e ed du ing he fi s chemo he apy cycle.
As o he ela ionship be ween he quali y o li e and he
specific chemo he apy cycle, no significan di e ence was ound
(P=.154). Howe e , by analyzing he e ec size, a g ea end is
obse ed be ween he quali y o li e in he fi s cycle and he
second cycle (Cohen d=0.81). In pa icula , he e is a highe
quali y o li e du ing he fi s cycle (mean=15.16) han du ing he
second cycle (mean=13.81). In all o he cycles, he e ec size is
no significan .
Likewise, looking a he di e en indica o s o quali y o li e on
he gene al popula ion o he s udy, i is obse ed ha mos
pa ien s conside ha hey ha e no p oblems wi h walking
(73.4%), sel -ca e (95.4%), e e yday ac i i ies (53.2%) and, in
addi ion, hey a e no anxious o dep essed (63.9%). In con as ,
56.9% o pa ien s eel mode a e pain o discom o , and 67.9%
pe cei e hei o e all heal h wo se han hey did a yea ago.
On he o he hand, i is impo an o no e ha 3 pa ien s had o
be in bed and 1 pa ien was unable o pe o m daily ac i i ies. In
addi ion, 4 pa ien s el a lo o pain o discom o in ha cycle,
and 5 pa ien s el e y anxious o dep essed.
3.1. Gas oin es inal oxici y
S a is ically significan di e ences ha e been es ablished o he
ela ionship nausea-quali y o li e [U (77)=440, P=.020], wi h
Table 1
Desc ip ion o he sample in e ms o ea men cha ac e is ics.
Numbe o pa ien s % o pa ien s
Cycle Fi s cycle 29 26.4%
Second cycle 29 26.4%
Thi d cycle 19 17.3%
Fo h cycle 24 21.8%
Fi h cycle 9 8.2%
Adju ancy Neoadju ancy 49 44.5%
Adju ancy 61 55.5%
Dose eadjus men No 59 52.3%
Yes 51 47.7%
Hospi alisa ion No 74 66.4%
Yes 36 33.6%
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an a e age e ec size (Cohen d=0.56). In pa icula , wo se
quali y-o -li e indica o s a e obse ed in hose pa ien s who
epo ha ing su e ed nausea (mean=13.88), as compa ed wi h
hose who do no ha e his symp om (mean=14.88). In addi ion,
when analyzing each o he quali y-o -li e componen s, i is
obse ed ha pa ien s wi h nausea ha e wo se anxie y o
dep ession indica o s [x
2
(2)=7.600, P=.022, C ame V=
0.267]. In pa icula , 54.9% o pa ien s wi h nausea showed no
anxie y o dep ession indica o s, as compa ed wi h 80.6% o
pa ien s who did no p esen his oxici y (Table 2).
As o omi ing, dia hea, cons ipa ion, and mucosi is, no
s a is ically significan di e ences ha e been ound in ela ion o
he quali y o li e, and he e ec size has been negligible, excep
o mucosi is, whe e he e is a small size e ec (Cohen d=0.46). I
has no been possible o es ablish i s influence on each o he
quali y-o -li e componen s.
Table 2
Dis ibu ion o he di e en indica o s o heal h- ela ed quali y o li e based on gas oin es inal oxici y indica o s.
Vomi ing Nausea Dia hoea Cons ipa ion
No Yes No Yes No Yes No Yes
Mobili y I ha e no p oblems walking 73.2% (71) 72.7% (8) 77.8% (28) 70.8% (51) 76.8% (43) 69.8% (37) 71.6% (48) 75.0% (30)
I ha e some p oblems walking 23.7% (23) 27.3% (3) 22.2% (8) 25.0% (18) 21.4% (12) 26.4% (14) 25.4% (17) 22.5% (9)
I ha e o s ay in bed 3.1% (3) 0.0% (0) 0.0% (0) 4.2% (3) 1.8% (1) 3.8% (2) 3.0% (2) 2.5% (1)
Pe sonal ca e I ha e no p oblems wi h pe sonal
ca e
95.9% (93) 90,0% (9) 97.2% (35) 94.4% (67) 92.9% (52) 98.1% (51) 93.9% (62) 97.5% (39)
I ha e some p oblems washing
mysel and ge ing d essed
4.1% (4) 10,0% (1) 2.8% (1) 5.6% (4) 7.1% (4) 1.9% (1) 6.1% (4) 2.5% (1)
I canno wash mysel o ge
d essed
0.0% (0) 0,0% (0) 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0)
Daily ac i i ies I ha e no p oblems pe o ming
my daily ac i i ies
53.6% (52) 45,5% (5) 55.6% (20) 51.4% (37) 58.9% (33) 47.2% (25) 50.7% (34) 55.0% (22)
I ha e some p oblems
pe o ming my daily ac i i ies
45.4% (44) 54,5% (6) 44.4% (16) 47.2% (34) 41.1% (23) 50.9% (27) 47.8% (32) 45.0% (18)
I canno pe o m my daily
ac i i ies
1.0% (1) 0,0% (0) 0.0% (0) 1.4% (1) 0.0% (0) 1.9% (1) 1.5% (1) 0.0% (0)
Pain/discom o I ha e no pain o discom o 42.3% (41) 18,2% (2) 52.8% (19) 33.3% (24) 48.2% (27) 30.2% (16) 38.8% (26) 42.5% (17)
I ha e mode a e pain o
discom o
54.6% (53) 72,7% (8) 47.2% (17) 61.1% (44) 50.0% (28) 64.2% (34) 56.7% (38) 55.0% (22)
I ha e a lo o pain o discom o 3.1% (3) 9,1% (1) 0.0% (0) 5.6% (4) 1.8% (1) 5.7% (3) 4.5% (3) 2.5% (1)
Anxie y/dep ession I am no anxious o dep essed 61.9% (60) 80,0% (8) 80.6% (29) 54.9% (39) 69.6% (39) 57.7% (30) 66.7% (44) 57.5% (23)
I am mode a ely anxious o
dep essed
34.0% (33) 10,0% (1) 19.4% (7) 38.0% (27) 26.8% (15) 36.5% (19) 30.3% (20) 35.0% (14)
I am e y anxious o dep essed 4.1% (4) 10,0% (1) 0.0% (0) 7.0% (5) 3.6% (2) 5.8% (3) 3.0% (2) 7.5% (3)
Heal h s a us Be e 10.1% (7) 0,0% (0) 8.0% (2) 9.6% (5) 8.3% (3) 9.5% (4) 6.3% (3) 14.3% (4)
Same 23.2% (16) 25,0% (2) 36.0% (9) 17.3% (9) 13.9% (5) 31.0% (13) 20.8% (10) 28.6% (8)
Wo se 66.7% (46) 75,0% (6) 56.0% (14) 73.1% (38) 77.8% (28) 59.5% (25) 72.9% (35) 57.1% (16)
Mucosi is Dysgeusia Loss o appe i e
No Yes No Yes No Yes
I ha e no p oblems walking 75.8% (47) 69.6% (32) 92.3% (12) 70.8% (68) 80.0% (44) 66.7% (36)
Mobili y I ha e some p oblems walking 22.6% (14) 26.1% (12) 7.7% (1) 26.0% (25) 18.2% (10) 29.6% (16)
I ha e o s ay in bed 1.6% (1) 4.3% (2) 0.0% (0) 3.1% (3) 1.8% (1) 3.7% (2)
I ha e no p oblems wi h pe sonal ca e 96.8% (60) 93.3% (42) 92.3% (12) 95.8% (91) 96.4% (53) 94.3% (50)
Pe sonal ca e I ha e some p oblems washing mysel
and ge ing d essed
3.2% (2) 6.7% (3) 7.7% (1) 4.2% (4) 3.6% (2) 5.7% (3)
I canno wash mysel o ge d essed 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0)
I ha e no p oblems pe o ming my daily
ac i i ies
54.8% (34) 50.0% (23) 76.9% (10) 50.0% (48) 65.5% (36) 40.7% (22)
Daily ac i i ies I ha e some p oblems pe o ming my
daily ac i i ies
43.5% (27) 50.0% (23) 23.1% (3) 49.0% (47) 34.5% (19) 57.4% (31)
I canno pe o m my daily ac i i ies 1.6% (1) 0.0% (0) 0.0% (0) 1.0% (1) 0.0% (0) 1.9% (1)
I ha e no pain o discom o 46.8% (29) 30.4% (14) 84.6% (11) 33.3% (32) 49.1% (27) 29.6% (16)
Pain/discom o I ha e mode a e pain o discom o 51.6% (32) 63.0% (29) 15.4% (2) 62.5% (60) 50.9% (28) 63.0% (34)
I ha e a lo o pain o discom o 1.6% (1) 6.5% (3) 0.0% (0) 4.2% (4) 0.0% (0) 7.4% (4)
I am no anxious o dep essed 66.1% (41) 60.0% (27) 84.6% (11) 61.1% (58) 70.9% (39) 56.6% (30)
Anxie y / dep ession I am mode a ely anxious o dep essed 33.9% (21) 28.9% (13) 15.4% (2) 33.7% (32) 27.3% (15) 35.8% (19)
I am e y anxious o dep essed 0.0% (0) 11.1% (5) 0.0% (0) 5.3% (5) 1.8% (1) 7.5% (4)
Be e 10.9% (5) 6.5% (2) 16.7% (1) 8.3% (6) 10.3% (4) 7.7% (3)
Heal h s a us Same 23.9% (11) 22.6% (7) 50.0% (3) 20.8% (15) 35.9% (14) 10.3% (4)
Wo se 65.2% (30) 71.0% (22) 33.3% (2) 70.8% (51) 53.8% (21) 82.1% (32)
In pa en heses: numbe o pa ien s.
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In e ms o loss o appe i e, s a is ically significan di e ences
ha e been ound [U (78)=455, P=.002], wi h an a e age e ec
size (Cohen d=0.77). In pa icula , wo se quali y-o -li e
indica o s a e obse ed in pa ien s who epo loss o appe i e
(mean=13.56), as compa ed wi h hose who do no show his
p oblem (mean=14.87).
Based on he influence on each o he quali y-o -li e
componen s, i is obse ed ha pa ien s wi h loss o appe i e
ha e wo se indica o s ega ding daily ac i i ies [x
2
(2)=7.251,
P=.027, C ame V=0.258], pain o discom o [x
2
(2)=7.386,
P=025, C ame V=0.260], and gene al heal h s a us [x
2
(2)=
7.981, P=.018, C ame V=0.320].
Finally, dysgeusia show s a is ically significan di e ences [U
(78)=107, P=.038] and a la ge e ec size (Cohen d=0.89). In
pa icula , wo se quali y-o -li e ou comes a e shown in pa ien s
wi h as e impai men (mean=14.10), as compa ed wi h hose
who do no show his al e a ion (mean=15.67).
In addi ion, when analyzing each o he quali y-o -li e
componen s, i is obse ed ha pa ien s wi h dysgeusia ha e
wo se pain o discom o indica o s [x
2
(2)=12.643, P=.002,
C ame V=0.341].
3.2. De ma ological oxici y
In e ms o de ma ological oxici ies, no s a is ically significan
di e ences in skin eac ion in hands and/o ee and in impai ed
nails ha e been ound. In bo h oxici ies, he e ec size has been
negligible. Likewise, hese de ma ological oxici ies ha e no
shown any s a is ical ela ionship wi h he di e en quali y-o -li e
componen s.
In con as , ega ding skin alle gies, he e a e s a is ically
significan di e ences [U (76)=213, P=.014) and a la ge e ec
size (Cohen d=0.88). In pa icula , be e quali y-o -li e
indica o s a e shown in pa ien s wi h skin alle gies (mean=
15.50), as compa ed wi h hose who do no e e his symp om
(mean=13.95). No di e ences ha e been ound be ween each o
he quali y-o -li e componen s. Howe e , by analyzing he e ec
size, di e ences can be ound ega ding he gene al heal h s a e
[x
2
(2)=5.275, P=.072, C ame V=0.263]. In pa icula ,
66.7% o pa ien s wi h skin alle gies show a wo se gene al
heal h s a us, as compa ed wi h 67.2% o pa ien s wi hou his
oxici y (Table 3).
3.3. Neu ological oxici y
Pe iphe al neu opa hy has been con as ed wi h he quali y o
li e, finding s a is ically significan di e ences [U (77)=185,
P=.000] and also a la ge e ec size (Cohen d=1.34). In
pa icula , wo se heal h- ela ed quali y o li e indica o s a e
ound in pa ien s who claim o ha e pe iphe al neu opa hy
(mean=12.53), as compa ed wi h hose who do no (mean=
14.68).
Subsequen ly, as shown in Table 4, i is obse ed ha pa ien s
wi h pe iphe al neu opa hy ha e wo se pe sonal ca e indica o s
[x
2
(1)=4.608, P=.032, C ame V=0.208], daily ac i i ies
[x
2
(2)=9.525, P=.009, C ame V=0.297], pain o discom o
[x
2
(2)=11.725, P=0.003, C ame V=0.329], and anxie y o
dep ession [x
2
(2)=6.032, P=0.049, C ame V=0.237].
3.4. Pain- ela ed oxici y
As o headaches, abdominal pain, and join pain, no s a is ically
significan di e ences ha e been ound, and he e ec size is
small. On he o he hand, when analyzing each o he quali y-o -
li e componen s, no di e ence can be ound as ega ds he
p esence o absence o hese oxici ies.
In con as , ega ding abdominal pain, he e a e di e ences as
o pain o discom o [x
2
(2)=5.118, P=0.077, C ame V=
0.218] and gene al heal h s a us [x
2
(2)=3.206, P=.201, C ame
V=0.204). In e ms o join pain, he e a e di e ences in pain o
discom o indica o s [x
2
(2)=15.368, P=.000, C ame V=
0.377].
Table 3
Dis ibu ion o he di e en indica o s o heal h- ela ed quali y o li e based on de ma ological oxici y indica o s.
Hands/ ee skin eac ion Nail oxici y Skin alle gies
No Yes No Yes No Yes
Mobili y I ha e no p oblems walking 70.4% (57) 81.5% (22) 73.0% (54) 73.5% (25) 68.6% (59) 90.5% (19)
I ha e some p oblems walking 25.9% (21) 18.5% (5) 24.3% (18) 23.5% (8) 27.9% (24) 9.5% (2)
I ha e o s ay in bed 3.7% (3) 0,0% (0) 2.7% (2) 2.9% (1) 3.5% (3) 0.0% (0)
Pe sonal ca e I ha e no p oblems wi h pe sonal ca e 95.1% (77) 96.2% (25) 95.9% (70) 94.1% (32) 94.2% (81) 100.0% (20)
I ha e some p oblems washing mysel
and ge ing d essed
4.9% (4) 3.8% (1) 4.1% (3) 5.9% (2) 5.8% (5) 0.0% (0)
I canno wash mysel o ge d essed 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0)
Daily ac i i ies I ha e no p oblems pe o ming my daily ac i i ies 50.6% (41) 59.3% (16) 59.5% (44) 41.2% (14) 51.2% (44) 61.9% (13)
I ha e some p oblems pe o ming my daily ac i i ies 49.4% (40) 37.0% (10) 39.2% (29) 58.8% (20) 47.7% (41) 38.1% (8)
I canno pe o m my daily ac i i ies 0.0% (0) 3.7% (1) 1.4% (1) 0.0% (0) 1.2% (1) 0.0% (0)
Pain/discom o I ha e no pain o discom o 42.0% (34) 29.6% (8) 44.6% (33) 29.4% (10) 37.2% (32) 47.6% (10)
I ha e mode a e pain o discom o 55.6% (45) 63.0% (17) 51.4% (38) 67.6% (23) 58.1% (50) 52.4% (11)
I ha e a lo o pain o discom o 2.5% (2) 7.4% (2) 4.1% (3) 2.9% (1) 4.7% (4) 0.0% (0)
Anxie y / dep ession I am no anxious o dep essed 63.0% (51) 65.4% (17) 65.8% (48) 61.8% (21) 59.3% (51) 80.0% (16)
I am mode a ely anxious o dep essed 33.3% (27) 26.9% (7) 28.8% (21) 35.3% (12) 34.9% (30) 20.0% (4)
I am e y anxious o dep essed 3.7% (3) 7.7% (2) 5.5% (4) 2.9% (1) 5.8% (5) 0.0% (0)
Heal h s a us Be e 8.6% (5) 10.5% (2) 12.7% (7) 0.0% (0) 6.3% (4) 25.0% (3)
Same 24.1% (14) 21.1% (4) 21.8% (12) 27.3% (6) 26.6% (17) 8.3% (1)
Wo se 67.2% (39) 68.4% (13) 65.5% (36) 72.7% (16) 67.2% (43) 66.7% (8)
In pa en heses: numbe o pa ien s.
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As o muscle pain, s a is ically significan di e ences ha e
been ound [U (77)=436, P=.003], and he e ec size is
mode a e (Cohen d=0.76). In pa icula , wo se quali y-o -li e
indica o s a e ound in hose pa ien s wi h myalgia (mean=13.6,
9), as compa ed wi h hose who do no show his symp om
(mean=15.00). Then, when analyzing each o he quali y-o -li e
componen s, i is obse ed ha pa ien s wi h myalgia ha e wo se
pain o discom o [x
2
(2)=16.166, P=.000, C ame V=0.387]
and gene al heal h s a us indica o s [x
2
(2)=7.831, P=.020,
C ame V=0.319) (Table 5).
3.5. Eye oxici y
Rega ding conjunc i i is, no s a is ically significan di e ences
ha e been ound, bu an app op ia e, al hough small, e ec size is
shown (Cohen d=0.35). Rega ding his oxici y, wo se quali y-
o -li e indica o s a e obse ed in pa ien s wi h he conjunc i i is
(mean=13.83), as compa ed wi h hose who do no show his
symp om (mean=14.46).
By analyzing each o he quali y-o -li e componen s, no
s a is ically significan di e ence has been ound be ween hem.
Howe e , by analyzing he e ec size, di e ences in he gene al
heal h s a us a e ound [x
2
(2)=3.337, P=.189, C ame V=
0.207]. In pa icula , 80.0% o pa ien s wi h conjunc i i is a e
hei gene al heal h s a us as wo se, as compa ed wi h 60.4% o
pa ien s who do no ha e his eye oxici y (Table 6).
3.6. Cons i u ional symp oms
The p esence o as henia has hen been con as ed wi h he
quali y o li e, whe e no s a is ically significan di e ences ha e
been ound and he e ec size has been mode a e (Cohen d=
0.64). In pa icula , wo se quali y-o -li e indica o s a e ound in
hose pa ien s who e e as henia (mean=14.09), as compa ed
wi h hose who do no show his oxici y (mean=15.25).
On he o he hand, when analyzing each o he quali y-o -li e
componen s, i is obse ed ha pa ien s wi h as henia ha e wo se
mobili y [x
2
(2)=11.442, P=.003, C ame V=0.325], daily
ac i i ies [x
2
(2)=6.137, P=.046, C ame =0.238), and pain o
discom o indica o s [x
2
(2)=6.762, P=.034, C ame V=.250]
(Table 7).
3.7. Lympha ic sys em oxici y
In e ms o oxici y a ec ing he lympha ic sys em, pe iphe al
edema, s a is ically significan di e ences, and a la ge e ec size
ha e been ound (Cohen d=0.88). In pa icula , pa ien s wi h
pe iphe al edema (mean=13.20) show wo se quali y-o -li e
indica o s han hose wi hou his oxici y (mean=14.69).
Then, when analyzing each o he quali y-o -li e componen s, i
is obse ed ha pa ien s wi h pe iphe al edema ha e wo se
mobili y [x
2
(2)=19.875, P=.000, C ame V=0.429], pain o
discom o [x
2
(2)=9.875, P=.007, C ame V=0.302], and
gene al heal h s a us indica o s [x
2
(2)=7.096, P=029, C ame
V=0.304] (Table 8).
Co ela ions be ween ad e se eac ions and heal h- ela ed
quali y o li e a e summa ized in Table 9.
4. Discussion
Chemo he apy ea men s a e ela ed o majo oxici ies ha
mus be closely moni o ed by he doc o a each o he pa ien ’s
consul a ions, p io o he adminis a ion o he nex chemo-
he apy cycle, in a simila way o he collec ion o oxici ies in he
con ex o a clinical ial. Howe e , in s anda d clinical p ac ice,
he pa ien ’s assump ion ha oxici ies a e una oidable and
in insic o he ea men makes he collec ion o nonhema o-
logical ad e se eac ions incomple e.
Meanwhile, as P ies man and Baum
[28]
demons a ed in 1976,
he influence o ad e se eac ions on he quali y o li e o cance
pa ien s is highly ele an . The e a e s udies
[32]
ha show ha
low quali y o li e nega i ely p edisposes o he onse o ce ain
diseases, including b eas cance . The e o e, i can be concluded
Table 4
Dis ibu ion o he di e en indica o s o heal h- ela ed quali y o li e based on neu ological oxici y indica o s.
Pe iphe al neu opa hy
No Yes
Mobili y I ha e no p oblems walking 76.2% (64) 62.5% (15)
I ha e some p oblems walking 21.4% (18) 33.3% (8)
I ha e o s ay in bed 2.4% (2) 4.2% (1)
Pe sonal ca e I ha e no p oblems wi h pe sonal ca e 97.6% (82) 87.0% (20)
I ha e some p oblems washing mysel and ge ing d essed 2.4% (2) 13.0% (3)
I canno wash mysel o ge d essed 0.0% (0) 0.0% (0)
Daily ac i i ies I ha e no p oblems pe o ming my daily ac i i ies 59.5% (50) 29.2% (7)
I ha e some p oblems pe o ming my daily ac i i ies 40.5% (34) 66.7% (16)
I canno pe o m my daily ac i i ies 0.0% (0) 4.2% (1)
Pain/discom o I ha e no pain o discom o 46.4% (39) 16.7% (14)
I ha e mode a e pain o discom o 52.4% (44) 70.8% (17)
I ha e a lo o pain o discom o 1.2% (1) 12.5% (3)
Anxie y/dep ession I am no anxious o dep essed 67.9% (57) 47.8% (11)
I am mode a ely anxious o dep essed 29.8% (25) 39.1% (9)
I am e y anxious o dep essed 2.4% (2) 13.0% (3)
Heal h s a us Be e 10.0% (6) 5.9% (1)
Same 28.3% (17)
Wo se 61.7% (3) 88.2% (15)
In pa en heses: numbe o pa ien s.
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ha a poo es quali y o li e has a nega i e impac on add essing
he ea men p ocess.
The esul s o his s udy highligh he nega i e impac o
oxici ies such as nausea, dysgeusia, pe iphe al neu opa hy, loss
o appe i e, myalgia, and pe iphe al edema on b eas cance
pa ien s’quali y o li e. As Ga cía-Luna e al
[33]
show, nausea,
dysgeusia, and loss o appe i e induce he onse o malnu i ion in
he cance pa ien . This leads o a dec ease in muscle mass and,
he e o e, a o s o e all weakness o he pa ien . I s impac
implies, in addi ion o dec easing quali y o li e (da a
Table 6
Dis ibu ion o he di e en indica o s o heal h- ela ed quali y o li e based on eye oxici y indica o s.
Conjunc i i is
No Yes
Mobili y I ha e no p oblems walking 78.8% (52) 65.1% (28)
I ha e some p oblems walking 18.2% (12) 32.6% (14)
I ha e o s ay in bed 3.0% (2) 2.3% (1)
Pe sonal ca e I ha e no p oblems wi h pe sonal ca e 95.5% (63) 95.2% (40)
I ha e some p oblems washing mysel and ge ing d essed 4.5% (3) 4.8% (2)
I canno wash mysel o ge d essed 0.0% (0) 0.0% (0)
Daily ac i i ies I ha e no p oblems pe o ming my daily ac i i ies 54.5% (36) 51.2% (22)
I ha e some p oblems pe o ming my daily ac i i ies 45.5% (30) 46.5% (20)
I canno pe o m my daily ac i i ies 0.0% (0) 2.3% (1)
Pain/discom o I ha e no pain o discom o 43.9% (29) 32.6% (14)
I ha e mode a e pain o discom o 53.0% (35) 62.8% (27)
I ha e a lo o pain o discom o 3.0% (2) 4.7% (2)
Anxie y/dep ession I am no anxious o dep essed 62.1% (41) 66.7% (28)
I am mode a ely anxious o dep essed 33.3% (22) 28.6% (12)
I am e y anxious o dep essed 4.5% (3) 4.8% (2)
Heal h s a us Be e 10.4% (5) 6.7% (2)
Same 29.2% (14) 13.3% (4)
Wo se 60.4% (29) 80.0% (24)
In pa en heses: numbe o pa ien s.
Table 5
Dis ibu ion o he di e en indica o s o heal h- ela ed quali y o li e based on pain- ela ed oxici y indica o s.
Headache Abdominal pain Join pain Muscle pain
No Yes No Yes No Yes No Yes
Mobili y I ha e no p oblems walking 68.0% (34) 77.6% (45) 72.7% (48) 73.8% (31) 80.5% (33) 68.7% (46) 80.0% (36) 69.8% (44)
I ha e some p oblems walking 30.0% (15) 19.0% (11) 24.2% (16) 23.8% (10) 17.1% (7) 28.4% (19) 17.8% (8) 27.0% (17)
I ha e o s ay in bed 2.0% (1) 3.4% (2) 3.0% (2) 2.4% (1) 2.4% (1) 3.0% (2) 2.2% (1) 3.2% (2)
Pe sonal ca e I ha e no p oblems wi h pe sonal
ca e
98.0% (49) 93.0% (53) 95.5% (63) 95.1% (39) 97.6% (40) 93.9% (62) 95.6% (43) 95.2% (59)
I ha e some p oblems washing
mysel and ge ing d essed
2.0% (1) 7.0% (4) 4.5% (3) 4.9% (2) 2.4% (1) 6.1% (4) 4.4% (2) 4.8% (3)
I canno wash mysel o ge
d essed
0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0) 0.0% (0)
Daily ac i i ies I ha e no p oblems pe o ming
my daily ac i i ies
50.0% (25) 55.2% (32) 59.1% (39) 42.9% (18) 58.5% (24) 49.3% (33) 64.4% (29) 46.0% (29)
I ha e some p oblems
pe o ming my daily ac i i ies
50.0% (25) 43.1% (25) 40.9% (27) 54.8% (23) 41.5% (17) 49.3% (33) 35.6% (16) 52.4% (33)
I canno pe o m my daily
ac i i ies
0.0% (0) 1.7% (1) 0.0% (0) 2.4% (1) 0.0% (0) 1.5% (1) 0.0% (0) 1.6% (1)
Pain/discom o I ha e no pain o discom o 48.0% (24) 32.8% (19) 47.0% (31) 28.6% (12) 63.4% (26) 25.4% (17) 62.2% (28) 23.8% (15)
I ha e mode a e pain o
discom o
48.0% (24) 63.8% (37) 51.5% (34) 64.3% (27) 34.1% (14) 70.1% (47) 35.6% (16) 71.4% (45)
I ha e a lo o pain o discom o 4.0% (2) 3.4% (2) 1.5% (1) 7.1% (3) 2.4% (1) 4.5% (3) 2.2% (1) 4.8% (3)
Anxie y/dep ession I am no anxious o dep essed 66.0% (33) 61.4% (35) 72.7% (48) 48.8% (20) 61.0% (25) 65.2% (43) 68.9% (31) 59.7% (37)
I am mode a ely anxious o
dep essed
30.0% (15) 33.3% (19) 22.7% (15) 46.3% (19) 36.6% (15) 28.8% (19) 26.7% (12) 35.5% (22)
I am e y anxious o dep essed 4.0% (2) 5.3% (3) 4.5% (3) 4.9% (2) 2.4% (1) 6.1% (4) 4.4% (2) 4.8% (3)
Heal h s a us Be e 10.8% (4) 7.5% (3) 8.7% (4) 9.7% (3) 12.0% (3) 7.7% (4) 18.8% (6) 2.2% (1)
Same 29.7% (11) 17.5% (7) 30.4% (14) 12.9% (4) 24.0% (6) 23.1% (12) 28.1% (9) 20.0% (9)
Wo se 59.5% (22) 75.0% (30) 60.9% (28) 77.4% (24) 64.0% (16) 69.2% (36) 53.1% (17) 77.8% (35)
In pa en heses: numbe o pa ien s.
P ie o-Calleje o e al. Medicine (2020) 99:33 www.md-jou nal.com
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co obo a ed in his s udy), an inc ease in dependence on ca e by
amily membe s o ca egi e s and an inc eased s a e o
immunosupp ession, which is associa ed wi h he isk o
in ec ious complica ions. I is easonable o conclude ha all
o his will psychologically a ec he cance pa ien .
Fu he mo e, i is no ewo hy ha 89.9% o pa ien s deny
ha ing su e ed an episode o omi ing and ha 75.2% o hem
ha e no su e ed pe iphe al edema du ing he las 21 days.
Howe e , omi ing is commonly epo ed as associa ed wi h
hese chemo he apy ea men s.
[9]
The low incidence o omi ing
e e ed o in his s udy may be due o he high e ficacy o he used
p ophylac ic an ieme ic: ap epi an .
[34,35]
Howe e , ea men
wi h ap epi an does no educe nausea, some hing ha is
confi med by 67.0% o pa ien s in his s udy who claim o ha e
su e ed i . Likewise, he p ophylac ic use o co icos e oids may
be associa ed wi h he low pe cen age o pe iphe al edema
epo ed.
In addi ion, o he oxici ies such as mucosi is, headache,
abdominal pain, a h algia, conjunc i i is, and as henia showed a
nega i e end on he pa ien s’quali y o li e, so i could be
expec ed ha , by inc easing he sample size, his end would
become clea e and s a is ically significan .
Likewise, his s udy demons a es he nega i e implica ion o
he di e en oxici ies on each o he heal h- ela ed quali y-o -li e
Table 8
Dis ibu ion o he di e en indica o s o heal h- ela ed quali y o li e based on lympha ic sys em oxici y indica o s.
Pe iphe al edema
No Yes
Mobili y I ha e no p oblems walking 82.7% (67) 44.4% (12)
I ha e some p oblems walking 13.6% (11) 55.6% (15)
I ha e o s ay in bed 3.7% (3) 0.0% (0)
Pe sonal ca e I ha e no p oblems wi h pe sonal ca e 97.5% (79) 88.5% (23)
I ha e some p oblems washing mysel and ge ing d essed 2.5% (2) 11.5% (3)
I canno wash mysel o ge d essed 0.0% (0) 0.0% (0)
Daily ac i i ies I ha e no p oblems pe o ming my daily ac i i ies 58.0% (47) 37.0% (10)
I ha e some p oblems pe o ming my daily ac i i ies 42.0% (34) 59.3% (16)
I canno pe o m my daily ac i i ies 0.0% (0) 3.7% (1)
Pain/discom o I ha e no pain o discom o 48.1% (39) 14.8% (4)
I ha e mode a e pain o discom o 49.4% (40) 77.8% (21)
I ha e a lo o pain o discom o 2.5% (2) 7.4% (2)
Anxie y/dep ession I am no anxious o dep essed 69.1% (56) 46.2% (12)
I am mode a ely anxious o dep essed 25.9% (21) 50.0% (13)
I am e y anxious o dep essed 4.9% (4) 3.8% (1)
Heal h s a us Be e 11.5% (6) 4.0% (1)
Same 30.8% (16) 8.0% (2)
Wo se 57.7% (30) 88.0% (22)
In pa en heses: numbe o pa ien s.
Table 7
Dis ibu ion o he di e en indica o s o heal h- ela ed quali y o li e based on cons i u ional symp om indica o s.
As henia
No Yes
Mobili y I ha e no p oblems walking 87.5% (14) 70.7% (65)
I ha e some p oblems walking 0.0% (0) 28.3% (26)
I ha e o s ay in bed 12.5% (2) 1.1% (1)
Pe sonal ca e I ha e no p oblems wi h pe sonal ca e 100.0% (13) 94.5% (86)
I ha e some p oblems washing mysel and ge ing d essed 0.0% (0) 5.5% (5)
I canno wash mysel o ge d essed 0.0% (0) 0.0% (0)
Daily ac i i ies I ha e no p oblems pe o ming my daily ac i i ies 81.3% (13) 47.8% (44)
I ha e some p oblems pe o ming my daily ac i i ies 18.8% (3) 51.1% (47)
I canno pe o m my daily ac i i ies 0.0% (0) 1.1% (1)
Pain/discom o I ha e no pain o discom o 68.8% (11) 34.8% (32)
I ha e mode a e pain o discom o 31.3% (5) 60.9% (56)
I ha e a lo o pain o discom o 0.0% (0) 4.3% (4)
Anxie y/dep ession I am no anxious o dep essed 75.0% (12) 61.5% (56)
I am mode a ely anxious o dep essed 25.0% (4) 33.0% (30)
I am e y anxious o dep essed 0.0% (0) 5.5% (5)
Heal h s a us Be e 0.0% (0) 10.1% (7)
Same 37.5% (3) 21.7% (15)
Wo se 62.5% (5) 68.1% (47)
In pa en heses: numbe o pa ien s.
P ie o-Calleje o e al. Medicine (2020) 99:33 Medicine
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indica o s. Focusing on each o he quali y-o -li e a iables, he e
a e di e ences in he in ol emen o ce ain oxici ies in he
di e en componen s.
On he one hand, he anxie y o dep ession indica o emains
a ec ed by nausea, mucosi is, pe iphe al neu opa hy, and
abdominal pain. As ega ds pain o discom o , 7 oxici ies
would be in ol ed: loss o appe i e, dysgeusia, pe iphe al
neu opa hy, a h algia, myalgia, as henia, and pe iphe al edema.
Daily ac i i ies a e influenced by loss o appe i e, pe iphe al
neu opa hy, and as henia. This las oxici y also has an impac on
he mobili y indica o , in addi ion o pe iphe al edema. Pe sonal
ca e is only a ec ed by pe iphe al neu opa hy.
In he case o pe iphe al neu opa hy and pe iphe al edema, i is
no ewo hy ha despi e ob aining a below 25% pe cen age o
p esence in he s udy pa ien s, hese a e oxici ies ha
significan ly a ec quali y o li e. This may be due o he lack
o alidi y o all he symp oms associa ed wi h hese a iables.
[6]
Pe iphe al neu opa hy is also wo h no ing because i is he
oxici y ha a ec s a g ea e numbe o quali y-o -li e indica o s
(anxie y o dep ession, pain o discom o , daily ac i i ies, and
pe sonal ca e). This may be due o he se e i y o his oxici y as i
a ec s he whole o ganism, om deep pain ollowed by
numbness, mainly in he hands and ee , muscle in ol emen
wi h a eeling o weakness, as well as p oblems wi h diges ing,
sexual ela ionships, hea in ol emen , and mo e.
Beus e ien e al
[18]
demons a ed in hei s udy ha b eas
cance pa ien s p io i ized ce ain side e ec s, such as pe iphe al
neu opa hy, o e o he s, such as alopecia, which hey conside ed
mino . They e en claimed o be willing o accep a less con enien
chemo he apy ea men scheme o a oid an inc eased isk o side
e ec s such as pe iphe al neu opa hy.
In sho , despi e he ad ances in he con ol o symp oms
associa ed wi h chemo he apy ea men s, he pa ien ’s pe cep-
ion is s ill a pending ask o all heal h wo ke s. These mus be
awa e o he impo ance o knowing he pa ien and hus
a oiding hospi al admissions, delays in chemo he apy cycles, o
e en suspension o he cycles as a esul o accumula ed
oxici y.
[11,14]
As o he limi a ions o his s udy, as a 1-cen e s udy, he e is a
possibili y ha he s udy popula ion will be subjec ed o ce ain
common bias. In addi ion, he ques ionnai e was ca ied ou
andomly in a specific cycle o he 6 co esponding o he
comple e ea men o he pa ien , so he e is a possibili y ha he
s udied cycle was no he one in which he pa ien p esen ed a
highe numbe o oxici ies. Simila ly, as an obse a ional design,
causal ela ionships canno be es ablished, and we can only alk
o co ela ions be ween he a iables. The e o e, u he s udies
wi h a la ge sample size would be needed o co obo a e he
esul s and conclusions o his s udy.
In gene al, quali y-o -li e esul s highligh he need o imp o e
he assessmen o he e ec s o he ea men on he pa ien s’
quali y o li e. This could be he goal o de eloping a sel - efillable
ques ionnai e ega ding he pa ien s’pe cep ion o hei own
heal h s a us and symp oms o ob ain mo e in o ma ion and
mo e de ailed da a on hese issues h ough pa ien sel -
assessmen . Pa ien s could b ing his sel -assessmen home o
ha e a digi al eco d a ailable wi h he aim o ob aining mo e
comple e da a on he ad e se eac ions su e ed du ing he 21
days he pa ien is a home. In his line, he e a e s udies
[9,34]
ha
ha e analyzed he pe cei ed quali y o li e o pa ien s as
compa ed wi h he usual p ac ice, which show ha quali y o
li e is a ec ed by he ca e ecei ed in hospi als du ing he pa ien ’s
illness, hus highligh ing he lack o in o ma ion ha heal h
p o essionals ha e abou pa ien s’pe cep ions.
The impo ance o in oducing a mul idisciplina y eam aimed
a imp o ing he accep ance o chemo he apy in hese pa ien s
has been demons a ed in a coho s udy conduc ed among
13,722 b eas cance pa ien s.
[36]
This is why his could be a line
o imp o emen in eal ca e o hese ypes o cance pa ien s.
On he o he hand, i would be necessa y o aise awa eness
among heal hca e p o essionals o he impo ance o ad e se
eac ions in chemo he apeu ic ea men s. Cance pa ien s may
eel mo e welcomed by he heal h sys em and mo e pa icipa i e
in e e y hing ha a ec s he e olu ion o hei ea men and
disease.
[11]
In conclusion, he p esence o ad e se eac ions ela ed o he
TEC ea men scheme significan ly dec eases heal h- ela ed
quali y o li e. In pa icula , nausea, loss o appe i e, dysgeusia,
pe iphe al neu opa hy, myalgia, and pe iphe al edema a e hose
oxici ies whe e his di e ence has been significan .
Au ho con ibu ions
Concep ualiza ion: Blanca P ie o-Calleje o.
Da a cu a ion: Blanca P ie o-Calleje o, F ancisco Ri e a.
Fo mal analysis: Blanca P ie o-Calleje o, F ancisco Ri e a,
Adol o Rome o, Maca ena Rome o-Ma ín.
In es iga ion: Blanca P ie o-Calleje o, Adol o Rome o, Ca los
Ruiz-F u os.
Me hodology: F ancisco Ri e a, Ja ie Fagundo-Ri e a, Adol o
Rome o, Maca ena Rome o-Ma ín, Juan Gómez-Salgado,
Ca los Ruiz-F u os.
P ojec adminis a ion: Blanca P ie o-Calleje o.
Resou ces: F ancisco Ri e a, Ja ie Fagundo-Ri e a, Juan
Gómez-Salgado, Ca los Ruiz-F u os.
So wa e: F ancisco Ri e a, Ja ie Fagundo-Ri e a.
Supe ision: Adol o Rome o, Juan Gómez-Salgado.
Valida ion: F ancisco Ri e a, Adol o Rome o.
Table 9
Co ela ion be ween ad e se eac ions and heal h- ela ed quali y
o li e.
Ad e se eac ion Mann–Whi ney U es PCohen d
Vomi ing 267 (77) .879 0.13
Nausea 440 (77) .020
∗
0.56
Dia hea 746 (78) .923 0.03
Cons ipa ion 613 (76) .522 0.17
Mucosi is 548 (77) .081 0.46
Loss o appe i e 455 (78) .002
∗
0.77
Dysgeusia 107 (78) .038
∗
0.89
Skin eac ion in
hands and/o ee
510 (77) .626 0.09
Impai ed nails 564 (77) .642 0.14
Skin alle gies 213 (76) .014 0.88
Pe iphe al neu opa hy 185 (77) .000
∗
1.34
Myalgia 628 (77) .248 0.30
Abdominal pain 559 (77) .104 0.37
Join pain 502 (77) .103 0.39
Muscle pain 436 (77) .003
∗
0.76
Conjunc i i is 581 (78) .148 0.35
As henia 168 (77) .068 0.64
Pe iphe al edema 337 (77) .001
∗
0.88
∗
S a is ically significan .
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