Nav: Home

Study: Prioritize cardiac monitoring for high-risk breast cancer patients

August 06, 2018

Overall, heart failure is an uncommon complication of breast cancer treatment; however, the risk is higher in patients treated with certain types of chemotherapy and lower in younger patients, according to a study in a special "Imaging in Cardio-oncology" issue of JACC: Cardiovascular Imaging. Researchers concluded that cardiac monitoring should be a higher priority for high-risk patients.

Cardiovascular disease is the second leading cause of death of breast cancer survivors, behind secondary malignancies, due in part to the cardiac toxicities of some cancer therapies. However, little is known about the rate of chemotherapy-related cardiotoxicity and the rate of cardiac monitoring adherence among breast cancer patients treated with chemotherapy.

In this study, cardiotoxicity was defined as an incident case of heart failure following a breast cancer diagnosis. The study included 16,456 patients with a median age of 56 years who were treated with chemotherapy within six months of their diagnosis. Of those, 4,325 patients received trastuzumab-based chemotherapy.

Trastuzumab-based chemotherapy is a common treatment for patients with HER2-positive breast cancer, a very aggressive type of cancer. It has consistently been shown to benefit patients, but it is also associated with cardiotoxicity.

The study found that 8.3 percent of the trastuzumab-treated patients developed heart failure versus 2.7 percent of patients who did not receive trastuzumab. Among patients who were treated with trastuzumab, 46.2 percent received guideline-adherent cardiac monitoring, which according to the National Comprehensive Cancer Network, is before initiating treatment and every three months while on the treatment. Researched also saw that as age increased, there was a consistent increase in the risk of heart failure.

This was the first study of its kind to estimate cardiotoxicity rates and cardiac monitoring using data on both younger and older women from the MarketScan database. Previous studies focused on older women who have higher rates of heart failure than reported in clinical trials, but this study focused more on younger women, who usually have fewer comorbidities and are similar to patients in previous trastuzumab trials. Younger women may receive more aggressive chemotherapy because they have a longer life expectancy, making them an important group to study for cardiac toxicity and cardiac monitoring.

Researchers said there could be many explanations for the low rates of cardiac monitoring seen in the patients treated with trastuzumab, including a low perceived need on the part of the physicians, rather than an unawareness of the guidelines.

"We must remember that while cardiac monitoring is recommended in different guidelines, such recommendations are not based on category 1 data, and the timing recommended, and the intervals of testing are rather arbitrary," said Mariana L. Henry, lead author of the study and a graduate student at Yale School of Public Health. "In examining the rate of both cardiac monitoring and cardiotoxicity we could begin to address the controversial issue of whether cardiac monitoring is warranted in young breast cancer patients."

This study is one of several papers featured in a special issue dedicated to imaging in cardio-oncology. Other studies/papers include:
  • Radiation Associated Cardiac Disease: a practical approach to diagnosis and management

  • Anthracycline Therapy Is Associated With Cardiomyocyte Atrophy and Preclinical Manifestations of Heart Disease

  • Contemporary Role of Echocardiography for Clinical Decision Making in Patients During and After Cancer Therapy

-end-
To request a copy of any study in the issue, email Nicole Napoli at nnapoli@acc.org.

The American College of Cardiology is the professional home for the entire cardiovascular care team. The mission of the College and its more than 52,000 members is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, offers cardiovascular accreditation to hospitals and institutions, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more, visit acc.org.

The Journal of the American College of Cardiology ranks among the top cardiovascular journals in the world for its scientific impact. JACC is the flagship for a family of journals--JACC: Cardiovascular Interventions, JACC: Cardiovascular Imaging, JACC: Heart Failure, JACC: Clinical Electrophysiology and JACC: Basic to Translational Science--that prides themselves in publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at JACC.org.

American College of Cardiology

Related Cancer Articles:

Radiotherapy for invasive breast cancer increases the risk of second primary lung cancer
East Asian female breast cancer patients receiving radiotherapy have a higher risk of developing second primary lung cancer.
Cancer genomics continued: Triple negative breast cancer and cancer immunotherapy
Continuing PLOS Medicine's special issue on cancer genomics, Christos Hatzis of Yale University, New Haven, Conn., USA and colleagues describe a new subtype of triple negative breast cancer that may be more amenable to treatment than other cases of this difficult-to-treat disease.
Metabolite that promotes cancer cell transformation and colorectal cancer spread identified
Osaka University researchers revealed that the metabolite D-2-hydroxyglurate (D-2HG) promotes epithelial-mesenchymal transition of colorectal cancer cells, leading them to develop features of lower adherence to neighboring cells, increased invasiveness, and greater likelihood of metastatic spread.
UH Cancer Center researcher finds new driver of an aggressive form of brain cancer
University of Hawai'i Cancer Center researchers have identified an essential driver of tumor cell invasion in glioblastoma, the most aggressive form of brain cancer that can occur at any age.
UH Cancer Center researchers develop algorithm to find precise cancer treatments
University of Hawai'i Cancer Center researchers developed a computational algorithm to analyze 'Big Data' obtained from tumor samples to better understand and treat cancer.
New analytical technology to quantify anti-cancer drugs inside cancer cells
University of Oklahoma researchers will apply a new analytical technology that could ultimately provide a powerful tool for improved treatment of cancer patients in Oklahoma and beyond.
Radiotherapy for lung cancer patients is linked to increased risk of non-cancer deaths
Researchers have found that treating patients who have early stage non-small cell lung cancer with a type of radiotherapy called stereotactic body radiation therapy is associated with a small but increased risk of death from causes other than cancer.
Cancer expert says public health and prevention measures are key to defeating cancer
Is investment in research to develop new treatments the best approach to controlling cancer?
UI Cancer Center, Governors State to address cancer disparities in south suburbs
The University of Illinois Cancer Center and Governors State University have received a joint four-year, $1.5 million grant from the National Cancer Institute to help both institutions conduct community-based research to reduce cancer-related health disparities in Chicago's south suburbs.
Leading cancer research organizations to host international cancer immunotherapy conference
The Cancer Research Institute, the Association for Cancer Immunotherapy, the European Academy of Tumor Immunology, and the American Association for Cancer Research will join forces to sponsor the first International Cancer Immunotherapy Conference at the Sheraton New York Times Square Hotel in New York, Sept.

Related Cancer Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Setbacks
Failure can feel lonely and final. But can we learn from failure, even reframe it, to feel more like a temporary setback? This hour, TED speakers on changing a crushing defeat into a stepping stone. Guests include entrepreneur Leticia Gasca, psychology professor Alison Ledgerwood, astronomer Phil Plait, former professional athlete Charly Haversat, and UPS training manager Jon Bowers.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".