While heart failure is an uncommon complication of breast cancer treatment, the risk may be higher in patients treated with certain types of chemotherapy and lower in younger patients, according to a study published Aug. 6 in the JACC: Cardiovascular Imaging. The study is part of a special "Imaging in Cardio-Oncology" focus issue, and researchers conclude that cardiac monitoring should be a higher priority for high-risk patients.

Mariana L. Henry, BS, et al., studied 16,456 patients with a median age of 56 years who were treated with chemotherapy within six months of their diagnosis. Of those, 4,325 patients received trastuzumab-based chemotherapy.

Results showed that 8.3 percent of the trastuzumab-treated patients developed heart failure vs. 2.7 percent of patients who did not receive trastuzumab. Researchers also observed that as age increased, there was a consistent increase in the risk of heart failure. Among patients who were treated with trastuzumab, 46.2 percent received guideline-adherent cardiac monitoring, which according to the National Comprehensive Cancer Network, is before initiating treatment and every three months while on the treatment.

Researchers said there could be many explanations for the low rates of cardiac monitoring seen in the patients treated with trastuzumab, including a low perceived need on the part of the physicians, rather than an unawareness of the guidelines.

"We must remember that while cardiac monitoring is recommended in different guidelines, such recommendations are not based on category 1 data, and the timing recommended, and the intervals of testing are rather arbitrary," said Henry. "In examining the rate of both cardiac monitoring and cardiotoxicity we could begin to address the controversial issue of whether cardiac monitoring is warranted in young breast cancer patients."

In a related editorial comment, Chau T. Dang, MD, et al., note that "strong collaboration between our cardiology and oncology communities is critical as we aim to optimally treat patients with the most effective cancer therapy, with minimal interruption, while achieving the best short- and long-term cardiac outcomes."

Keywords: Middle Aged, Cardiotoxicity, Heart Failure, Breast Neoplasms

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