Physician and hospital TTE surveillance for anthracycline cardiotoxicity varies widely, with 41.5% physicians and 27.6% hospitals performing no TTEs in HER2- breast cancer patients.
Does echocardiographic surveillance for cardiotoxicity vary between HER2+ and HER2- breast cancer patients receiving anthracyclines?
There is significant hospital- and physician-level variability and underutilization of echocardiographic surveillance for cardiotoxicity in older breast cancer patients receiving anthracyclines, particularly among those with HER2- disease.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Transthoracic echocardiography (TTE) is a reliable, non-invasive, and sensitive method for detecting cardiotoxicity in patients with breast cancer undergoing anthracycline chemotherapy. Professional society guidelines stipulate TTE surveillance every 3 months for HER2+ breast cancer; however guideline recommendations vary for HER2- breast cancer. As such, it is uncertain whether hospital and referring physician TTE surveillance practices vary across breast cancer types. Methods Using the 2010-2020 Surveillance, Epidemiology, and End Results (SEER) Medicare dataset, we identified older adults (≥ 65 years) with breast cancer who received anthracyclines for a first cancer diagnosis. Hospital- and physician-level variability in outpatient TTE surveillance in the first year after chemotherapy initiation were evaluated by HER2+ status using coefficients of variability (CoV). Results Of 5,413 individuals included (mean age: 70.5 ± 3.9 years, 98.8% female, 81.0% White), 307 (5.7%) were HER2+. Across 663 treating hospitals, the median number of TTEs/individual/year performed in HER2+ cancers was 2.00 (IQR: 1.00-3.75; CoV = 0.72; 18.1% performing no TTEs) and 0.50 (IQR: 0.00-1.00; CoV = 1.11; 27.6% performing no TTEs) for HER2- cancers (Figure 1). Across 2,211 referring physicians, the median number of TTEs/individual/year in HER2+ cancers was 3.00 (IQR: 1.00-4.00; CoV = 0.75; 20.9% physicians ordering no TTEs) and 0.50 (IQR: 0.00-1.00; CoV = 1.33; 41.5% of physicians ordering no TTEs) for HER2- cancers (Figure 2). Restricting to individuals with a baseline TTE within the year prior to chemotherapy (n = 4,196), results were overall similar. Conclusions Wide physician-level and hospital-level variability is present in TTE surveillance for patients receiving anthracyclines for breast cancer. Up to 41.5% of physicians and 27.6% of hospitals perform no surveillance TTEs for HER2- cancers. Where guidelines are clear for HER2+ cancers, TTE intensity is greater and variability is lower. These results suggest the need for improved evidence-based standardization of TTE surveillance practices.
Strom et al. (Sat,) reported a other. Physician and hospital TTE surveillance for anthracycline cardiotoxicity varies widely, with 41.5% physicians and 27.6% hospitals performing no TTEs in HER2- breast cancer patients.