scholarly journals P656 Cardiac dysfunction in breast cancer patients treated with anthracyclines: a single-center experience

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Cardoso Torres ◽  
C Sousa ◽  
J Simoes ◽  
P Maia Araujo ◽  
A Nunes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Cardiac Dysfunction ◽  
Global Longitudinal Strain ◽  
Antihypertensive Drug Therapy ◽  
Breast Cancer Patients ◽  
Single Center

Abstract Introduction Cardiac dysfunction is a well-documented side effect of cancer treatment, with significant morbidity and mortality. Cardio-oncology units play a vital role in the early identification and management of cancer therapy related cardiovascular side effects and provide a multidisciplinary care for cancer patients. Purpose To describe the incidence of cancer treatment related cardiac dysfunction (CTRCD) in a population of breast cancer patients (pts) under chemotherapy in a single center cardio-oncology unit, and to assess its predictors. Methods We retrospectively evaluated 83 women on anthracycline therapy for breast cancer, with or without anti-HER2 therapy, followed-up between January 2017 and July 2018. CTRCD was defined as more than 10% absolute reduction of LV ejection function (LVEF) to below 50%. Pts with >15% relative percentage reduction from baseline Global longitudinal strain (GLS) or with elevation of high-sensitivity Troponin I (hsTI) levels were considered to be at high risk for developing CTRCD and started cardioprotective treatment with an ACE inhibitor/ARB and a beta-blocker, as did pts with confirmed CRTCD. Also, in pts under antihypertensive drug therapy, switching drugs to cardioprotective ones was performed in the index consultation. Follow-up was organized in our cardio-oncology consultation at 0, 3, 6 and 12 months (or more frequently in selected high-risk cases). Interruption of chemotherapy was a joint decision of the oncology and cardiology teams. Results A total of 83 women with a mean age of 49 years (26-76) were included. 4 pts (4.8%) developed CTRCD. 28 pts (33.7%) were considered to be at high risk due to GLS reduction during follow-up and 17 pts (20.5%) were at high risk due to hsTI elevation. From all the baseline characteristics, only basal BNP correlated with CTRCD (p = 0.033). Other characteristics such as age, presence of cardiovascular risk factors and the previously proposed Cardiotoxicity Risk Score (CRS) did not. There was a high percentage of pts (51.8%; n = 43) under cardioprotective drugs. 37% of the pts initiated cardioprotective drugs following cardio-oncology consultation. Chemotherapy was discontinued in only 2 pts (2.4%). Conclusion CTRCD is difficult to predict by baseline clinical characteristics. Monitoring and management of CTRCD by a multidisciplinary cardio-oncology team resulted in a high rate of cardioprotective drugs use and low rate of permanent discontinuation of chemotherapy. Further studies are needed to further analyze the relationship between these two variables.

scholarly journals P1750 Association of high-sensitivity troponin elevation and LVEF decline in anthracycline-treated breast cancer patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Cardoso Torres ◽  
C Sousa ◽  
P Maia Araujo ◽  
J Simoes ◽  
A Nunes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Cardiac Dysfunction ◽  
High Sensitivity ◽  
Absolute Maximum ◽  
High Sensitivity Troponin ◽  
Percent Increase ◽  
Oncology Unit

Abstract Introduction Cancer therapies have been linked to a wide variety of side effects, with cardiotoxicity being the most significant one. Early detection of subclinical cardiac dysfunction in cancer patients (pts) is necessary in order to prevent unfavorable outcomes. High-sensitivity troponin I (hsTI) levels have been proposed as predictors of cancer therapy related cardiotoxicity and may guide cardioprotective therapy initiation. Purpose To describe the incidence of cancer treatment related cardiac dysfunction (CTRCD) in a population of breast cancer pts under chemotherapy in a single center cardio-oncology unit and to assess its relationship with hsTI levels. Methods We retrospectively evaluated 83 women on anthracycline therapy for breast cancer, with or without anti-HER2 therapy, followed-up between January 2017 and July 2018. CTRCD was defined as more than 10% absolute reduction of LV ejection function (LVEF) to a value below 50%. Elevation of hsTI was defined as at least one measurement above the 99th percentile upper reference limit during follow-up (>34 ng/L). Pts had an organized follow-up in our cardio-oncology unit, consisting of a clinical, laboratorial (with dosing of cardiac biomarkers) and echocardiographic assessment at 0, 3, 6 and 12 months (or more frequently in selected high-risk cases). Results A total of 83 women with a mean age of 49 years (26-76) were included. 4 pts (4.8%) developed CTRCD. 17 pts (20.5%) were considered at high risk of cardiac dysfunction due to hsTI elevation. During follow-up, the percent increase in the hsTI level (from basal level) correlated with CTRCD (p = 0.02). On the other hand, the absolute maximum value of hsTI did not (p = 0.159). In fact, pts who developed CTRCD had a significantly higher percent increase in the hsTI levels (142.9% +- 57.5%) vs those without CTRCD (14.29% +- 4.6%), p < 0.001. On ROC curve analysis, percent increase in troponin was a good identifier of CTRCD (AUC of 0.986; 95% CI 0.95-1.00; p = 0.022) and the best cut-off value was a 79.8% increase in hsTI (sensitivity: 100%; specificity: 97.2%). Conclusion In our population, the percent increase in the hsTI levels correlated with CTRCD. Larger studies are needed to prove this parameter as a predictor of CTRCD. Abstract P1750 Figure.

Study of Failure Pattern Among High-Risk Breast Cancer Patients With or Without Postmastectomy Radiotherapy in Addition to Adjuvant Systemic Therapy: Long-Term Results From the Danish Breast Cancer Cooperative Group DBCG 82 b and c Randomized Studies

2006 ◽  
Vol 24 (15) ◽  
pp. 2268-2275 ◽  
Author(s):  
Hanne M. Nielsen ◽  
Marie Overgaard ◽  
Cai Grau ◽  
Anni R. Jensen ◽  
Jens Overgaard
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Disease Recurrence ◽  
Breast Cancer Patients ◽  
High Risk Breast Cancer ◽  
High Risk Breast ◽  
Risk Breast Cancer

Purpose Postmastectomy radiotherapy (RT) in high-risk breast cancer patients can reduce locoregional recurrences (LRRs) and improve disease-free and overall survival. The aim of this analysis was to examine the overall disease recurrence pattern among patients randomly assigned to receive treatment with or without RT. Patients and Methods A long-term follow-up was performed among the 3,083 patients from the Danish Breast Cancer Cooperative Group 82 b and c trials, except in those already recorded with distant metastases (DM) or contralateral breast cancer (CBC). The end points were LRR, DM, and CBC, and the follow-up continued until DM, CBC, emigration, or death. Information was selected from medical records, general practitioners, and the National Causes of Death Registry. The median potential follow-up time was 18 years. Results The 18-year probability of any first breast cancer event was 73% and 59% (P < .001) after no RT and RT, respectively (relative risk [RR], 0.68; 95% CI, 0.63 to 0.75). The 18-year probability of LRR (with or without DM) was 49% and 14% (P < .001) after no RT and RT, respectively (RR, 0.23; 95% CI, 0.19 to 0.27). The 18-year probability of DM subsequent to LRR was 35% and 6% (P < .001) after no RT and RT, respectively (RR, 0.15; 95% CI, 0.11 to 0.20), whereas the probability of any DM was 64% and 53% (P < .001) after no RT versus RT, respectively (RR, 0.78; 95% CI, 0.71 to 0.86). Conclusion Postmastectomy RT changes the disease recurrence pattern in high-risk breast cancer patients; fewer patients have LRR as first site of recurrence, and overall fewer patients have DM.

Improving the delivery of team-based survivorship care after primary breast cancer treatment through a multi-level intervention.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7056-7056
Author(s):  
Lauren P. Wallner ◽  
Paul Abrahamse ◽  
Archana Radhakrishnan ◽  
Lawrence C. An ◽  
Jennifer J. Griggs ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Medical Oncology ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Breast Cancer Patients ◽  
Multi Level ◽  
Oncology Providers

7056 Background: The delivery of team-based survivorship care after primary cancer treatment remains challenging, in part due to a lack of effective interventions. We developed a multi-level intervention for breast cancer patients and their primary care and medical oncology providers to improve the delivery of team-based survivorship care called ConnectedCancerCare (CCC). CCC includes a patient-facing, personalized mobile website, and tailored feedback letters to providers. Methods: We conducted a pilot randomized controlled trial in a breast oncology clinic to establish the feasibility and acceptability of CCC. Women within one year of completing primary treatment for stages 0-II breast cancer were randomized to CCC (intervention) or a static online survivorship care plan (control). Participants completed online surveys at baseline and 3 months, ascertaining their knowledge about PCP roles in their survivorship care, their communication with their PCP about team-based care, and whether they scheduled a follow-up visit with their PCP. Multiple measures of acceptability were collected among women in the intervention arm (n = 28). Qualitative interviews were conducted at the completion of the study with 5 PCPs, 6 oncology providers, and 10 intervention patients to identify barriers and facilitators to implementing CCC. Results: Among 160 eligible women invited to participate, 66 women completed the baseline survey and were randomized (41% participation rate), and 54 completed the 3-month follow-up survey (83% response rate). Women in the intervention arm found the content of the CCC website to be highly acceptable, with 82% reporting it was easy to use, and 86% reporting they would recommend it to other patients. A greater proportion of women randomized to CCC (vs. control) reported scheduling a PCP follow-up visit (64% vs. 42%) and communicating with their PCP about provider roles (67% vs. 18%). Women in the CCC arm also reported higher mean knowledge scores regarding team-based cancer care (3.7 vs. 3.4). Providers noted challenges to implementing CCC, including integration into electronic medical records, and supporting sustained engagement with CCC over time. Conclusions: Our findings suggest deploying CCC in medical oncology practices is feasible, and the intervention content is acceptable among breast cancer patients. CCC shows promise for improving understanding and communication about provider roles in survivorship care, and facilitating patients to follow up with their PCP early in the survivorship period. Clinical trial information: NCT03618017 .

scholarly journals CARDIOTOXICITY RISK PREDICTION IN BREAST CANCER PATIENTS

2021 ◽  
Vol 26 ◽  
pp. 498-512
Author(s):  
S. Kozhukhov ◽  
◽  
N. Dovganych ◽  
I. Smolanka ◽  
O. Lygyrda ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
High Risk ◽  
Retrospective Analysis ◽  
Cancer Patients ◽  
Risk Prediction ◽  
Risk Model ◽  
Heart Function ◽  
Breast Cancer Patients

S. M. Kozhukhov1, N. V. Dovganych1, I. I. Smolanka2, O. F. Lygyrda2, О. Ye. Bazyka1, S. A. Lyalkin2, O. M. Ivankova2, O. A. Yarinkina1, N. V. Tkhor1 1 National Scientific Center «The M.D. Strazhesko Institute of Cardiology», 5 Narodnoho Opolchennia Str., Kyiv, 03680, Ukraine 2 National Cancer Institute of the Ministry of Health of Ukraine, 33/43 Lomonosova Str., Kyiv, 03022, Ukraine CARDIOTOXICITY RISK PREDICTION IN BREAST CANCER PATIENTS Breast cancer patients receive combined antitumor treatment (surgery, chemotherapy, targeted drugs and radiation), so they are considered to be the patients with potentially high risk of cardiotoxicity (CT). Risk stratification of cardiovascular complications before the beginning and during the cancer treatment is an important issue. Objective: to develop a CT risk model score taking into account cardiological, oncological and individual risks. Material and methods. The study included 52 breast cancer patients with retrospective analysis of their medical history, risk factors, and echocardiographic parameters before the onset and in 12 months follow up. Based on the analysis of the data, a CT risk model score was developed and recommended. The patients were divided into groups according to the score: Group 1 – low risk of CT development – score ≤ 4 points, Group 2 – moderate risk – 5–7 points, Group 3 – high risk ≥ 8 points. According to the scale, BC patients with a total of ≥ 8 points are considered to be at high risk for CT complications. Radiation therapy and anthracyclines, as well as associated cardiovascular diseases were the most important risk factors of CT. Results. Based on the study of retrospective analysis of risk factors, data of heart function monitoring during follow-up, the risk model score of cardiotoxicity has been developed for the BC patients’ stratification. According to the proposed score risk model, BC patients with a total score of ≥ 8 points considered to have high risk of cardiotoxic complications. Conclusions. Using of the proposed risk model score with calculation of CT risk factors both before the beginning and during cancer therapy is important, because it allows predicting the risk of CT development – to identify highrisk patients, accordingly, to develop an individualized plan for cardiac function monitoring and to start timely cardioprotective therapy. Key words: breast cancer, cardiotoxicity, heart failure, risk scale, prognosis.

Abstract 12440: Global Longitudinal Strain With 2D-Speckle Tracking Predicts Chemotherapy-related Systolic Dysfunction Independenty of Basal Assessment in Patients With Breast Carcinoma

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Federico Guerra ◽  
Marco Marchesini ◽  
Daniele Contadini ◽  
Alessio Menditto ◽  
Marco Morelli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
High Risk ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Breast Cancer Patients ◽  
2D Speckle Tracking

Introduction: Recent developments in anticancer therapies for breast carcinoma allowed an improvement in patient survival, notwithstanding a parallel increase of cardiovascular morbidity. Systolic dysfunction and heart failure represent a relevant problem in these patients due to insidious onset and the potential irreversible nature of cardiac damage. Therefore, strong and early predictors of chemoteraphy-realted systolic dysfunction are been sought. Hypothesis: To investigate global longitudinal strain (GLS) assessed by 2D-speckle tracking as a potential early marker of systolic dysfunction in chemoteraphy-treated breast cancer patients. Methods: Population include sixty-nine patients, referred to our unit for cardiologic assessment prior to neo-adjuvant or adjuvant chemotherapy for breast cancer. Patients with prior heart failure and atrial fibrillation were excluded. The protocol included a baseline echocolorDoppler and 2D-strain evaluation before the beginning of chemotherapy and subsequent serial controls every 3 months. In patients developing systolic dysfunction, further unscheduled assessment were made at the cardiologist discretion. Results: Nineteen (27.5%) patients were classified as having cardiotoxicity according to CREC and ESMO criteria. ROC curve analysis showed that a 3-month GLS <-16% predicted subsequent development of systolic dysfunction with good sensitivity and specificity (80% and 90% respectively), with a negative predictive value of 92%. Cardiotoxicity occurred in 8 patients at 6 months and in 11 patients within 9 months; among all of those, 84% of patients already showed a GLS <-16% at 3-month, and 100% at 6-month, confirming the early diagnostic potential of GLS. After chemotherapy suspension and introduction of cardioprotective drugs, GLS remained depressed longer than left ventricular ejection fraction (LVEF) over 1-year follow-up. Conclusions: Strain imaging with 2D-speckle tracking allows the identification of patients at high risk of developing systolic dysfunction. An absolute cut-off value of -16% can provide a useful, time-independent clinical tool to improve follow-up management and concentrate resources on high-risk patients.

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