A large Ontario study shows that the early monitoring of heart health in women on certain anticancer treatments – specifically those that are known to increase risk of heart failure – is not being carried out according to heart disease risk levels.
"This means that some of the women who are in greatest need of preventative therapies for heart failure may not be getting the care they need," says the lead author of the study,
Dr. Paaladinesh Thavendiranathan, Scientist at Toronto General Hospital Research Institute (TGRI), cardiologist at the Peter Munk Cardiac Centre, and Assistant Professor in the University of Toronto's Department of Medicine.
The study, which was published in the
Journal of Clinical Oncology, used Ontario-wide data for 18,444 women that were diagnosed with early-stage breast cancer between 2007 and 2012. The data was used by the research team to identify the factors that determine whether women receive cardiac imaging – an essential procedure for assessing heart health – after diagnosis with breast cancer.
"Early monitoring of heart health is particularly important for women who go on to receive the chemotherapeutics anthracycline and/or trastuzumab, which can increase the risk of heart failure," says Dr. Thavendiranathan.
"For these individuals, knowing heart health before cancer treatment is essential for identifying who may benefit from preventative therapies."
The findings revealed that those women that were at greatest risk for heart complications – (such as those who received the chemotherapeutic anthracycline and displayed risk factors for heart disease including diabetes and hypertension) – were around a quarter less likely to receive early monitoring for heart health than women who received trastuzumab and had no risk factors for heart disease.
"We found that the type of chemotherapeutic prescribed was a key factor in determining whether patients received heart health monitoring," says Dr. Thavendiranathan. "These findings show that, in Ontario, a mismatch exists between monitoring and risk levels.
"Changing current policies to address this mismatch could help to reduce unnecessary monitoring, while also ensuring that those at high risk for cardiac complications receive the care that they need."
This work was supported by the Heart and Stroke Foundation, the University of Toronto, the Canadian Institutes of Health Research, the Institute for Clinical Evaluative Sciences, the Ontario Ministry of Health and Long-Term Care, the Ted Rogers Centre for Heart Research and the Toronto General & Western Hospital Foundation.
