Routine prechemotherapy screening may be skipped in patients without CV risk factors
A study examining the validity of baseline cardiac screening for left ventricular ejection fraction (EF) has found that only two (1.1 percent) of the screened patients have an abnormal EF (<50 percent). These patients have received doxorubicin (anthracycline) chemotherapy despite a compromised EF.
“[T]heir treating clinicians believed that the benefits of chemotherapy outweighed the risk of potential cardiac toxicity,” the investigators said.
A total of 179 patients (mean age, 59 years; 51 percent males) underwent gated blood pool scan (GBPS) predoxorubicin chemotherapy from 1 August 2009 to 31 July 2012.
Only 1.1 percent (n=2) of patients had an abnormal EF <50 percent, while 18 percent (n=33) had an EF 51‑59 percent and 80 percent (144) had an EF ≥60 percent. Anthracycline-based chemotherapy was still administered to the two patients with reduced baseline EF.
All 135 patients without any known cardiovascular risk factors showed normal EFs. A total of 207 patients received anthracycline chemotherapy during the same period. Accordingly, there were 28 patients (13 percent) who initiated anthracycline without a prior GBPS.
“Our audit questions the practice of routine cardiac evaluation pre-anthracycline screening with GBPS,” the authors said. “We propose that routine screening only be requested if cardiac risk factors are present.”
A retrospective 3-year audit was performed on patients who underwent GBPS prior to anthracycline chemotherapy. The authors identified patients via records from the Department of Nuclear Medicine and collected patient demographics, cancer type, cardiac risk factors, GBPS EF and cumulative anthracycline dose. Pharmacy dispensing records identified those who received doxorubicin.
“Anthracycline-based chemotherapy is used in many malignancies. Current recommendations by several groups suggest cardiac monitoring prior to and during anthracycline therapy,” the authors said.