Author + information
- Biniyam G. Demissei, MD, MSc, PhDa,∗@BiniyamD@pennmedicine,
- Srinath Adusumalli, MD, MSca,∗@sri_adu,
- Rebecca A. Hubbard, PhDb,
- Srinivas Denduluri, PhDa,
- Vivek Narayan, MD, MSCEc,d,
- Amy S. Clark, MD, MSCEc,d,
- Payal Shah, MDc,d,
- Hayley Knollman, MDc,d,
- Kelly D. Getz, MPH, PhDe,
- Richard Aplenc, MD, PhD, MSCEe,
- Joseph R. Carver, MDa,d and
- Bonnie Ky, MD, MSCEa,b,d,∗ ()
- aDepartment of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- bDepartment of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- cDivision of Hematology and Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- dAbramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- eDivision of Oncology, The Children’s Hospital of Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Bonnie Ky, University of Pennsylvania School of Medicine, Smilow Center for Translational Research, 3400 Civic Center Boulevard, 11-105, Philadelphia, Pennsylvania 19104.
Background There is limited evidence regarding the impact of cardiology involvement in the care of cancer patients.
Objectives This study evaluated the impact of cardiology involvement on guideline-adherent cardiovascular monitoring and risk factor management in patients with breast cancer treated with trastuzumab.
Methods In a single-center retrospective cohort study, electronic health records from 1,047 patients with breast cancer receiving trastuzumab between January 2009 and July 2018 were evaluated. A visit to a cardiology provider beginning from the 3 months before cancer therapy initiation until the last contact date defined cardiology involvement. Guideline-adherent monitoring, defined by echocardiography assessment within the 4 months before trastuzumab initiation and follow-up echocardiography at least every 4 months during therapy, was compared in patients with and without cardiology involvement before treatment initiation. Multivariable associations between cardiology involvement and the time-varying risk factors blood pressure and body mass index (BMI) were assessed by using generalized estimating equations.
Results Cardiology involvement occurred in 293 (28%) patients. A higher proportion of patients with cardiology involvement before trastuzumab initiation had guideline-adherent monitoring (76.4% vs. 60.1%; p = 0.007). Cardiology involvement was associated with an average 1.5 mm Hg (95% CI: –2.9 to –0.1; p = 0.035) lower systolic blood pressure, which was more pronounced in those with hypertension (–2.7 mm Hg; 95% CI: –4.6 to –0.7; p = 0.007). Cardiology involvement was associated with a lower BMI in patients with baseline BMI ≥25 kg/m2 (mean difference: –0.5 kg/m2; 95% CI: –1.0 to –0.1; p = 0.027).
Conclusions Cardiology involvement in patients with breast cancer treated with trastuzumab is associated with greater adherence to cardiovascular monitoring and modest improvements in risk factor control.
↵∗ Drs. Demissei and Adusumalli are co-first authors.
This work was supported by the National Heart, Lung, and Blood Institute (R01-HL118018 (Dr. Ky) and the American Heart Association (TPA34910059, Dr. Ky). The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Dr. Hubbard has received grants to her institution from Humana, Pfizer, the Patient-Centered Outcomes Research Institute, the National Institutes of Health, and Veterans Affairs. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Beth A. Overmoyer, MD, served as Guest Associate Editor for this paper, and Anju Nohria, MD, served as Guest Editor-in-Chief for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: CardioOncology author instructions page.
- Received February 3, 2020.
- Revision received April 15, 2020.
- Accepted April 17, 2020.
- 2020 The Authors