Disgeusia relacionada à quimioterapia antineoplásica: fatores de risco, avaliação longitudinal e proposta de diferentes protocolos terapêuticos usando fotobiomodulação com laserterapia de baixa intensidade

Abstract

The objective of this study was to evaluate, in a cross-sectional manner, the frequency and risk factors for dysgeusia related to antineoplastic chemotherapy, to longitudinally monitor a group of patients with breast cancer and to analyze different photobiomodulation protocols performed with the Low Power Laser (LBI). ). ) to prevent this adverse event. An observational, retrospective, cross-sectional and quantitative study was carried out using data collection from the Electronic Patient Record (PEP) system of 7,425 patients with dysgeusia, during chemotherapy treatment at Hospital Haroldo Juaçaba/Instituto do Câncer do Ceará (HHJ/ ICC ) over a period of two years (2018/2019), in which clinical information, QT protocols and dysgeusia scores were disclosed. In a prospective, longitudinal and quantitative study that used a taste analysis of 68 patients with Breast Cancer undergoing the Doxorubicin-Cyclophosphamide chemotherapy protocol followed by Taxanes (AC-T) (2021/2023), clinical data were obtained, tests were performed objective and subjective tasting before each QT cycle, in addition to collecting the ECOG and BMI scales. Finally, a phase III, randomized, triple-blind, non-inferiority clinical trial, carried out from 2021 to 2023, guided by CONSORT and already registered with REBEC, was carried out in 180 patients with breast cancer treated with CA in the outpatient clinic. of HHJ/ICC oncology, divided into three study groups: positive control group using the combination of 2J red laser (V) + 3J infrared (IR) (Therapy XT, DMC®) at 23 points distributed symmetrically on the tongue at each 21 days in each cycle throughout QT with AC-T; a test group V (V+placebo IV) and a test group IV (IV+placebo V). The same tests as in the longitudinal study were used. Statistical analysis was performed blindly using the ANOVA-RM/Bonferroni, Friedman/Dunn, chi-square/Fisher's exact tests using the SPSS 20.0 software, adopting a confidence level of 95%. In the cross-sectional study, an incidence of Dysgeusia of 19% was described and numbers of QT cycles, sex, uterine cancer, head and neck tumors, testicular cancer, Ifosfamide, Docetaxel, Paclitaxel, Pertuzumab, Bevacizumab and Dacarbazine are risk factors. In the longitudinal study, the incidence of Dysgeusia increased from the third cycle of QT (p<0.001) and events of taste sensitivity <50% were directly associated with the number of chemotherapy cycles (p<0.001), reduced salivary flow (p =0.019), worse quality of life (p<0.05) and higher incidence of nausea and anorexia (p<0.05). Furthermore, age (p<0.001) and use of trastuzumab (p<0.001) were potential risk factors for dysgeusia. In the clinical trial, the LBI V(+placebo) and IV(+placebo) protocols (p<0.001) were inferior to the V+IV protocol in subjective (p<0.001) and objective tests (p<0.005), variation in ECOG and BMI. There is no significant variation in many adverse events. Dysgeusia related to chemotherapy occurs in 20% of patients, in women with breast cancer, without the AC-T protocol, age (p<0.001) and the use of trastuzumab (p<0.001) were potential risk factors. To avoid this effect, the LBI V+IV protocol is superior to the others alone.