The Yield of Routine Cardiac Imaging in Breast Cancer Patients Receiving Trastuzumab-Based Treatment: A Retrospective Cohort Study.
Anthracyclines
/ therapeutic use
Antineoplastic Agents, Immunological
/ administration & dosage
Breast Neoplasms
/ drug therapy
Canada
/ epidemiology
Cardiac Imaging Techniques
/ methods
Cardiotoxicity
/ diagnosis
Diagnostic Tests, Routine
/ methods
Drug Substitution
/ statistics & numerical data
Female
Heart Failure
/ chemically induced
Humans
Middle Aged
Patient Care Management
/ methods
Retrospective Studies
Trastuzumab
/ administration & dosage
Journal
The Canadian journal of cardiology
ISSN: 1916-7075
Titre abrégé: Can J Cardiol
Pays: England
ID NLM: 8510280
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
16
09
2019
revised:
09
12
2019
accepted:
21
12
2019
pubmed:
6
7
2020
medline:
20
5
2021
entrez:
5
7
2020
Statut:
ppublish
Résumé
There are limited data on the yield of routine cardiac imaging for trastuzumab-treated patients with breast cancer. We conducted a retrospective cohort study of patients with breast cancer treated with adjuvant trastuzumab between 2007 and 2012 at Princess Margaret Cancer Centre (Toronto, Canada). We classified imaging tests as clinically prompted or routinely ordered and determined whether each test led to changes in patient care. A generalized estimating equation model was used to determine if patient characteristics predicted routine studies more likely to change care. We analysed routine tests that were exclusively preceded by consecutive tests that did not change care to determine if their yield differed by time since trastuzumab start and the number of prior tests that did not change care. We identified 448 patients who received 1735 cardiac imaging studies after trastuzumab initiation. Of 1555 routine tests, 44 led to changes in care (2.8%) for 43 patients, whereas 50 of 180 clinically prompted tests (27.8%) altered care in 29 patients (P-value < 0.001). Earlier stage cancer, diabetes, prior anthracyclines, and prior cardiovascular disease were associated with a higher likelihood of changes in care following routine tests (P-value < 0.05). Among routine tests that were exclusively preceded by consecutive tests that did not change care, tests ordered outside months 3-9 and those that followed ≥ 3 tests were even less likely to change care. Routine cardiac imaging tests rarely changed care for trastuzumab-treated patients with breast cancer, particularly among lower risk anthracycline-naïve women who had multiple prior tests that did not change care.
Sections du résumé
BACKGROUND
There are limited data on the yield of routine cardiac imaging for trastuzumab-treated patients with breast cancer.
METHODS
We conducted a retrospective cohort study of patients with breast cancer treated with adjuvant trastuzumab between 2007 and 2012 at Princess Margaret Cancer Centre (Toronto, Canada). We classified imaging tests as clinically prompted or routinely ordered and determined whether each test led to changes in patient care. A generalized estimating equation model was used to determine if patient characteristics predicted routine studies more likely to change care. We analysed routine tests that were exclusively preceded by consecutive tests that did not change care to determine if their yield differed by time since trastuzumab start and the number of prior tests that did not change care.
RESULTS
We identified 448 patients who received 1735 cardiac imaging studies after trastuzumab initiation. Of 1555 routine tests, 44 led to changes in care (2.8%) for 43 patients, whereas 50 of 180 clinically prompted tests (27.8%) altered care in 29 patients (P-value < 0.001). Earlier stage cancer, diabetes, prior anthracyclines, and prior cardiovascular disease were associated with a higher likelihood of changes in care following routine tests (P-value < 0.05). Among routine tests that were exclusively preceded by consecutive tests that did not change care, tests ordered outside months 3-9 and those that followed ≥ 3 tests were even less likely to change care.
CONCLUSIONS
Routine cardiac imaging tests rarely changed care for trastuzumab-treated patients with breast cancer, particularly among lower risk anthracycline-naïve women who had multiple prior tests that did not change care.
Identifiants
pubmed: 32621888
pii: S0828-282X(19)31547-8
doi: 10.1016/j.cjca.2019.12.021
pii:
doi:
Substances chimiques
Anthracyclines
0
Antineoplastic Agents, Immunological
0
Trastuzumab
P188ANX8CK
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1658-1666Informations de copyright
Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.