Abstract:

Background: A high mortality has been reported during the ninety days of chemotherapy and is more pronounced in patients with febrile neutropenia (FN). Mortality in patients with febrile neutropenia has been found to range from 4-21% and can be higher when complicated with infection. Various factors such as age, comorbidities, type of cancer, type of chemotherapy and even dosage and stage have been implicated with this increase mortality. At Bugando Medical Center, it is estimated that more than 600 cancer patients receive chemotherapy annually. However, data on their treatment outcomes and factors associated with mortality are poorly understood.

Objective: This study aimed to determine mortality and associated factors within ninety days of patients starting chemotherapy at Bugando Medical Center, Oncology department.

Methodology: This hospital- based cross-sectional study with a follow-up component was conducted between August 2017 and May 2018 among patient aged 12 years and above starting the chemotherapy at oncology department. Participants underwent baseline physical examinations and functional status assessment using Karnofsky score. Blood and urine samples were then followed up to determine 90 days mortality. On each clinic visit, FBP was taken and patient investigate for infection. Data were entered in Microsoft excel and analyzed using STATA version 13.

Results: A total of 102 study participants were enrolled. Their median (IQR) age was 50 years (38-60). The majority of study participants were females 76(75%) and 82(80.4%) had primary school education. Ninety-six of enrolled patients had solid cancer. Mortality within 90 days of starting treatment in cancer patients in this study was found to be 12%. There was significance in median (IQR) hemoglobin level between study participants who died and those who survived 10g/dl[9.3-10.8] versus 11.8g/dl[10.5-12.7], (p=0.001). Having a performance status of 80% and less was also associated with mortality, (p=0.001). Using 5-Fluorouracil containing regime remained and independent predictor of 90 days mortality on multivariate logistic regression analysis (OR[95%CI] 7.0[1.63-30], P=0.019).

Conclusion: Mortality among cancer patient within 90 days of starting chemotherapy at oncology unit of Bugando Medical Center was higher than reported in other studies. Use of 5-Fluorouracil containing regimes in our patients was an independent predictor of mortality. Anemia and lower performance status were also associated with mortality.