Determinants and Management of Cardiac Toxicties Induced by Anthracycline-based Regimens in Adult Patients With Cancer at Kenyatta National Hospital

Abstract

Background: Anthracyclines are used in the standard treatment protocols for solid and hematological cancers. Despite their extensive usage, they cause cardiac toxicities. These toxicities require prompt management to reduce the risk of their complications. Objective: To investigate the determinants and management strategies of anthracyclines induced cardiotoxicities in adult patients with cancer at Kenyatta National Hospital. Methodology: A cross-sectional study was conducted at the Kenyatta National Hospital. A total of 149 adult cancer patients on the anthracycline-based regimen were recruited to participate in the study through consecutive sampling. Data was collected using a researcher administered questionnaire. The analysis was carried out using STATA version 13 and the level of significance set at 0.05. Results There was female predominance (97.3%) and twenty-two (14.8%) participants had comorbidities especially hypertension (10, 6.7%). The majority (140, 94.0%) had breast cancer and 59 (39.6%) had the disease for a duration of 1-2years. One hundred and thirty-four (89.9%) were using doxorubicin and cyclophosphamide combination. Nineteen (12.8%) participants had a reduced ejection fraction along with type I diastolic dysfunction. Independent predictors of cardiotoxicity were hypertension (p=0.026); trastuzumab use (p=0.011), occupation (p=0.046) and Body mass index (p=0.043) respectively. However, all the participants were not put on any intervention geared towards managing the cardiac toxicities. Conclusion High BMI was an independent predictor of cardiac toxicities. Similarly, the presence of hypertension and the use of trastuzumab were also identified as independent predictors of cardiac toxicities in patients using the anthracyclines-based regimen. Recommendations Weight reduction should be encouraged and hypertension appropriately controlled.