Cardiac monitoring in adolescent and young adult cancer patients treated with anthracyclines: a longitudinal descriptive study.

PURPOSE: We quantified the real-world prevalence of echocardiographic monitoring and identified factors associated with baseline echocardiography among adolescent and young adult (AYA; 15-39 years) cancer patients treated with anthracyclines in Japan.

METHODS

We performed a descriptive study using a Japanese health insurance claims database in patients initiating anthracycline chemotherapy between April 2012 and July 2020. We calculated the proportion undergoing echocardiography within 180 days before therapy (baseline); before the second, fourth, and sixth cycles; at any time during therapy; and within 1 year after completion. Risk ratios for receipt of baseline echocardiography by patient and institutional characteristics were estimated using univariable modified Poisson regression.

RESULTS

Among 1459 AYA patients (mean age, 31.7 years; 65.1% female), 60.4% underwent baseline echocardiography. Utilization declined to 8.2%, 11.4%, and 20.9% before the second, fourth, and sixth cycles, respectively; was 13.7% at any time during therapy; and 41.0% within 1-year post-therapy. Baseline echocardiography was more common for age 15-19 and 20-29 years (vs. ≥ 30-39 years) and males; lymphoma, leukemia, bone sarcoma, and pre-existing heart failure; and chemotherapy at a designated cancer hospital. Likelihood was lower for breast cancer; clinic (vs. university hospital); and epirubicin, idarubicin, or pirarubicin (vs. doxorubicin).

CONCLUSION

Echocardiographic monitoring before, during, and after anthracycline therapy in Japanese AYA patients is suboptimal, with marked disparities by age, sex, cancer type, anthracycline agent, and treatment setting. Targeted quality-improvement initiatives and harmonized risk-stratified monitoring pathways are needed to prevent unrecognized anthracycline-related cardiomyopathy in this vulnerable population.