Anthracycline chemotherapy and human epidermal growth receptor 2 (HER2) targeting agents are common cancer medications with known potential to cause cardiac dysfunction. Global guidelines for cardiac monitoring during treatment with cardiotoxic cancer agents are variable and largely consensus-based. This study aimed to assess current cardiac monitoring practice in breast cancer patients receiving anthracyclines and HER2 targeted agents.
A single centre retrospective review was undertaken to identify cardiac monitoring practices in breast cancer patients treated with an anthracycline and/or HER2 agent(s) from June 2016-October 2017. Cardiac monitoring practice was evaluated against recommendations in guidelines published by the American Society of Clinical Oncology (ASCO), European Society of Medical Oncology (ESMO), and the Cancer Institute of New South Wales (eVIQ),
During the study period 217 patients were treated with 222 treatment pathways containing an anthracycline and/or HER2 agent. In 90% of treatments, patients had at least one cardiac scan performed. A baseline cardiac scan was performed in 85% of patients. 45% of patients had at least two scans throughout treatment, 43% of these patients had their scans performed at different locations and 34% utilised both echocardiogram (ECHO) and multigated acquisition (MUGA) scans. Adherence to recommendations within cardiac monitoring guidelines was variable: ASCO 78%, ESMO 45% and eVIQ 74%. In total, 83% of all treatments were concordant with at least one guideline.
Disparity in guidelines likely impacts clinical applicability in a real-world setting resulting in diverse practice. Current cardiac monitoring practice is perhaps reflective of the low-level evidence guiding cardiac monitoring and questionable relevance for individual patients. While an optimal monitoring schedule is unclear, local adoption of a single guideline and use of consistent imaging techniques will improve accuracy and interpretation of longitudinal assessments.