Abstract
Background
There are limited data on the yield of routine cardiac imaging for trastuzumab-treated
patients with breast cancer.
Methods
We conducted a retrospective cohort study of patients with breast cancer treated with
adjuvant trastuzumab between 2007 and 2012 at Princess Margaret Cancer Centre (Toronto,
Canada). We classified imaging tests as clinically prompted or routinely ordered and
determined whether each test led to changes in patient care. A generalized estimating
equation model was used to determine if patient characteristics predicted routine
studies more likely to change care. We analysed routine tests that were exclusively
preceded by consecutive tests that did not change care to determine if their yield
differed by time since trastuzumab start and the number of prior tests that did not
change care.
Results
We identified 448 patients who received 1735 cardiac imaging studies after trastuzumab
initiation. Of 1555 routine tests, 44 led to changes in care (2.8%) for 43 patients,
whereas 50 of 180 clinically prompted tests (27.8%) altered care in 29 patients (P-value < 0.001). Earlier stage cancer, diabetes, prior anthracyclines, and prior cardiovascular
disease were associated with a higher likelihood of changes in care following routine
tests (P-value < 0.05). Among routine tests that were exclusively preceded by consecutive
tests that did not change care, tests ordered outside months 3-9 and those that followed
≥ 3 tests were even less likely to change care.
Conclusions
Routine cardiac imaging tests rarely changed care for trastuzumab-treated patients
with breast cancer, particularly among lower risk anthracycline-naïve women who had
multiple prior tests that did not change care.
Résumé
Contexte
Il y a peu de données sur les retombées des examens courants d’imagerie cardiaque
chez les patientes atteintes de cancer du sein traitées par le trastuzumab.
Méthodologie
Nous avons mené une étude de cohorte rétrospective portant sur des patientes atteintes
de cancer du sein ayant reçu un traitement adjuvant par le trastuzumab entre 2007
et 2012 au Princess Margaret Cancer Centre (Toronto, Canada). Nous avons classé les
examens d’imagerie selon leur indication clinique ou leur prescription courante et
déterminé si chacun avait entraîné une modification des soins prodigués aux patientes.
Un modèle d’équation d’estimation généralisée a servi à établir si les caractéristiques
des patientes permettaient de prévoir les cas où un examen courant était le plus susceptible
de donner lieu à une modification des soins. Nous avons analysé les examens courants
qui avaient été exclusivement précédés d’examens consécutifs n’ayant entraîné aucune
modification des soins pour déterminer si leurs retombées différaient en fonction
du temps écoulé depuis le début du traitement par le trastuzumab et du nombre d’examens
antérieurs n’ayant donné lieu à aucune modification des soins.
Résultats
Nous avons ciblé 448 patientes ayant subi 1 735 examens d’imagerie cardiaque après
la mise en route du traitement par le trastuzumab. Sur 1 555 examens courants, 44
avaient entraîné une modification des soins (2,8 %) chez 43 patientes, tandis que
50 des 180 examens indiqués sur le plan clinique (27,8 %) avaient eu le même effet
chez 29 patientes (p < 0,001). Le cancer peu avancé, le diabète, les traitements antérieurs par une anthracycline
et les antécédents de maladie cardiovasculaire étaient associés à une probabilité
plus élevée de modification des soins à la suite d’un examen courant (p < 0,05). Parmi les examens courants qui avaient été exclusivement précédés d’examens
consécutifs n’ayant entraîné aucune modification des soins, ceux qui avaient été prescrits
hors de l’intervalle allant du troisième au neuvième mois et ceux qui avaient suivi
au moins trois examens se sont révélés encore moins susceptibles d’entraîner une modification
des soins.
Conclusions
Les examens d’imagerie cardiaque courants ont rarement entraîné une modification des
soins prodigués aux patientes atteintes de cancer du sein traitées par le trastuzumab,
particulièrement chez les femmes à faible risque et sans antécédents de traitement
par une anthracycline qui avaient déjà subi plusieurs examens n’ayant entraîné aucune
modification des soins qu’elles recevaient.
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Article info
Publication history
Published online: December 28, 2019
Accepted:
December 21,
2019
Received:
September 16,
2019
Footnotes
See page 1665 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
