Cardiotoxicity and Cardiac Monitoring Among Anthracycline-Treated Cancer Patients: A Retrospective Cohort Study

Abstract

Purpose

Cardiotoxicity is a common complication associated with anthracyclines. Little is known regarding the rate of anthracyclines-related acute and chronic cardiotoxicity and adherence to cardiac monitoring recommendations among cancer patients.

Patients and Methods

A single-centre retrospective cohort study was conducted from 2015 to 2018 on patients with cancer, 18 years of age and older, on anthracyclines without a history of cardiovascular diseases. Data on demographic information, comorbidities, cardiovascular events, monitoring parameters, and treatment details were obtained. The primary outcome was the incidence of anthracyclines-related cardiotoxicity both acute and chronic. The secondary outcome was to determine adherence to guideline recommendations for monitoring anthracyclines-related cardiotoxicity based on the American Society of Clinical Oncology clinical practice guidelines. Analyses included descriptive statistics and logistic regression. Institutional review board approval was obtained.

Results

In 235 patients identified, 28.9% developed cardiotoxicity, of which 27.2% were acute, while chronic cardiotoxicity was observed in 8.9% of subjects. Patients who received optimal cardiac monitoring had a statistically significant higher odds of developing cardiotoxicities (odds ratio=2.65, confidence interval=1.32–5.33). The risk of cardiotoxicity was higher in subjects with a history of diabetes mellitus, those using daunorubicin, and concomitant filgrastim use. Adherence to guideline recommendations was only achieved in 25.1% of the population. Echocardiography was the most common monitoring method used.

Conclusion

In this study, there was a high incidence of anthracyclines cardiotoxicity and poor compliance with cardiac monitoring recommendations for cancer patients on anthracyclines, which underscores acute and chronic cardiotoxicity in this population.

Keywords:

• anthracyclines
• anthracyclines-induced cardiotoxicity
• cardiac monitoring
• cancer

Acknowledgments

We thank Undergraduate Research Support Program, for their support. This research project was supported by a grant from the “Research Center of the Center for Female Scientific and Medical Colleges”, Deanship of Scientific Research, King Saud University. We would also like to thank Miss Rahaf Almusned and Miss Lujain Alnoghaimshi for their assistance in data collection.

Abbreviations

ASCO, American Society of Clinical Oncology; BMI, body mass index; ECG, electrocardiogram; KSUMC, King Saud University Medical City; MRI, magnetic resonance imaging; MUGA, multiple-gated acquisition.

Data Sharing Statement

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Ethical Approval

The study was approved by the institutional review board of King Saud University (Institutional review board number E-18-3127). All data were anonymized to maintain participant’s privacy, and the study was conducted in accordance with the Declaration of Helsinki. In light of the retrospective and anonymous nature of the study, the Ethics Committee did not require written informed consent provided by participants.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The abstract of this paper was presented at the 9^th college of pharmacy research day (COPRD) at King Saud University, College of Pharmacy, as a presentation with interim findings. The authors report no conflicts of interest in this work.