Prevalence, Risk Factors and Interventional Strategies for Management of Thrombocytopenia Among Adult Patients Treated for Cancer at Kenyatta National Hospital

Abstract

Introduction: Thrombocytopenia is a usual complication in patients with cancer. Cancer drugs and the underlying disease processes are the most frequent causes of thrombocytopenia which can lead to dose modifications or delays. These interferences can result in poorer survival and disease progression. Limited data exist on the characteristics of cancer patients at risk of thrombocytopenia. Objective: This study sought to identify the prevalence and risks factors associated with thrombocytopenia in patients on cancer treatment and its interventional strategies. Methods: The study was conducted after being granted approval by KNH/UoN-ERC, KNH Research and Programs department and oncology department. This was a cross sectional study involving 137 participants who were above 18 years and initiated on cancer treatment between January 2019 and June 2022 at Kenyatta National Hospital-Cancer Treatment Center. They were selected by clustering the study population into hematological and solid malignancies, and then systematic sampling was done on each cluster. Data were abstracted from the participants’ files using a predesigned tool. Data were analyzed using STATA statistical software version 13. Descriptive data analysis was carried out, with categorical variables summarized by percentages and frequencies. Continuous data was summarized by median and interquartile range. Logistic regression was conducted to determine association between independent variables and the outcome variable. Results: More than half 93(67.9%) of the participants were female. Majority 51 (37.2%) were above 60 years. The median age was 52 years (IQR=25, 79). Solid cancers were the most prevalent at 108 (79%). Breast cancer was the most common type of cancer among the participants 39(28.9%), followed by cervical cancer 23(16.8%), esophageal cancer 14(10.2%) and multiple myeloma 14(10.2%). Most of the participants were in cancer stage IV 48(35.6%). Liver disease was the most preponderant comorbidity 22(16.1%) followed by kidney disease 16(11.8%). Doxorubicin and cyclophosphamide was the commonly used chemotherapeutic combination 13(9.5%) followed by cisplatin and paclitaxel combination 12(8.8%). The prevalence of thrombocytopenia in this study was xiv 43(31.4%) with majority having mild thrombocytopenia. There was no intervention instituted for participants with mild thrombocytopenia whereas platelet transfusion was the main intervention for those with severe thrombocytopenia. Participants with hematological malignancies had 0.02 times the odds of having thrombocytopenia compared to those with solid malignancies (OR=0.025, 95% CI 0.005, 0.129 p<0.001). Participants on carboplatin based regimens have 0.06 times the odds of having the thrombocytopenia as compared to the participants on the other regimens (OR=0.007, 95% CI 0.005, 0.577 p=0.015). Conclusion: The results suggest that thrombocytopenia in cancer patients at KNH is a relevant problem in clinical practice. The observed prevalence of thrombocytopenia was comparable with that observed in a recent Indian and Ugandan studies. Platelets transfusion was the main intervention for participants with severe thrombocytopenia