Only about a third of older breast cancer patients saw a cardiologist within 90 days of developing heart problems, according to a study presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions.
Breast cancer patients with heart problems who saw a cardiologist were more likely to receive standard therapy for their heart failure than those who did not. “The majority of older women who develop heart problems after their breast cancer therapy are not treated by a cardiologist, and they had lower quality of care,” the study's lead author, Jersey Chen, MD, MPH, a research scientist and cardiologist at Kaiser Permanente in Rockville, Maryland, said in a news release. “This suggests that this is an important area for oncologists and cardiologists to collaborate.”
He and his colleagues used a Medicare-linked database to identify women older than 65 who were diagnosed in 2000 to 2009 with stages I-III breast cancer who received cancer treatments that previously had been linked to cardiotoxicity.
The study tracked which patients developed cardiomyopathy or heart failure. Among the 8,400 breast cancer patients treated with either anthracyclines or trastuzumab, 1,028 (about 12%) developed heart problems within three years, and 345 (34%) saw a cardiologist within 90 days of their heart diagnosis. Women with heart failure after cancer treatment were more likely to be treated with standard medications if seen by a cardiologist compared with those who did not see a cardiologist.
“The bottom line is, if you have breast cancer and you're treated with anthracyclines or trastuzumab, you should know they have side effects,” Chen said. “And if you have symptoms of heart problems like shortness of breath or swelling in the feet or legs, seek attention quickly, preferably with doctors familiar and comfortable with treating heart failure after cancer therapy.
“Many cancer patients who develop heart failure or cardiomyopathy are not getting the necessary medications, regardless of whether they are seen by cardiologists. So there is work to be done to improve care for all women with cardiac complications after cancer therapy.”
Using 2006-2011 data from Medicare's Part D drug benefit, the researchers found that 60 percent of patients with heart problems who saw a cardiologist received ACE inhibitors or angiotensin receptor blockers, versus 44 percent of those who did not see a cardiologist. For beta-blockers, the figures were 40 versus 24 percent.
JERSEY CHEN, MD, MPH
People with other cancers—especially those who are older or have many other health problems—should also be vigilant for heart symptoms if they receive anthracyclines or trastuzumab, Chen added.
The study was funded by a three-year grant from the American Heart Association.