(144) Implementation and Adherence to Cancer Therapy-Related Cardiovascular Toxicity Monitoring Protocol in Breast Cancer and Gynecologic Oncology Patients

Poster Abstract:

Background: Anthracyclines and anti-HER2 (Human Epidermal Growth Factor Receptor 2) agents are commonly used in treating breast and gynecologic cancers. Cardiac dysfunction due to anthracyclines and/or anti-HER2 agents can manifest as left ventricular dysfunction (LVD), heart failure (HF), and arrhythmias. All could appear at initiation, during, or post treatment. Therefore, close monitoring of life-time dose is warranted to reduce the risk of potential cardiotoxicity. Hence, a standardized protocol to monitor patients receiving cardiotoxic anti-tumor agents is needed to standardize the practice among pharmacists to uniformly monitor patients to prevent potential cardiovascular toxicity.

Objective: To assess the rates of adherence to protocol and clinical intervention by clinical pharmacists in a breast and gynecologic oncology outpatient clinic.

Methods: This single-center, prospective cohort study will assess adherence by our clinical pharmacists to the hospital-approved “Cancer Therapy-Related Cardiovascular Toxicity Monitoring Protocol” entails assessment of patients for primary prophylaxis (dexarazoxane, Angiotensin-Converting-Enzyme inhibitors (ACEi)/Angiotensin Receptor Blockers (ARB) and beta-blockers (BB), and/or statins) need, monitor and record anthracycline accumulation dose and left ventricular ejection fraction (LVEF), and documentation of interventions (recommendations on primary prophylaxis and management of anthracycline and/or anti-HER2 agents in LVEF changes) made post-patients' evaluations. Patients whose cases will be evaluated are breast and gynecologic cancer patients (> 18-year-old) on anthracycline and/or anti-HER2 agents identified during the chemotherapy verification process. Patients enrolled in clinical trials are excluded. Data collection will be performed until 50 patients were included or until 45 days after protocol implementation date, whichever occurs first. The primary endpoints of this study are rates of adherence and intervention defined as number of patients with documentation in electronic medical record among patients who receive anthracyclines and/or anti-HER2 agents. Secondary endpoints include occurrence of primary prevention strategies in high-risk patients, recommendation acceptance rate, and pharmacist time expenditure.

Results: In-Progress

Conclusion: In-Progress

References (must also be included in final poster): Henriksen P. A. (2018). Anthracycline cardiotoxicity: an update on mechanisms, monitoring and prevention. Heart (British Cardiac Society), 104(12), 971–977. https://doi.org/10.1136/heartjnl-2017-312103

Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced Cardiotoxicity. Maedica (Bucur). 2013;8(1):59-67. 

Alexandre J, Cautela J, Ederhy S, Damaj GL, et al. Cardiovascular Toxicity Related to Cancer Treatment. J Am Heart Assoc. 2020;9(18):e018403. https://doi.org/10.1161/JAHA.120.018403