Breast cancer Long-term Outcome on Cardiac function: a longitudinal study

Laurine Van Der Wal, Saskia Maass, Truuske De Bock, Marjolein Berger, Daan Brandenbarg

Keywords: Breast cancer, cardiotoxicity, long-term outcomes, chemotherapy, radiotherapy

Background:

Breast Cancer (BC) is the most commonly diagnosed cancer among women in the Netherlands. Hence, every General Practitioner (GP) has around 25 BC survivors in his/her practice. In our previous, cross-sectional study, we showed that BC survivors (≥5 years after BC diagnosis, median 10 years) treated with chemo and/or radiotherapy were at increased risk of mild systolic cardiac dysfunction. To date the implications of the results in terms of guidelines for the GP are unclear and there are no evidence-based guidelines for long-term survivors of BC. Therefore, we aim to perform a second measurement among the same women.

Research questions:

What are the long term (>11 years) outcomes on cardiac function for women treated for BC compared to women without cancer of the same age? How does cardiac function change over time in women treated for BC compared to matched controls?

Method:

Longitudinal matched cohort study of two cohorts in primary care: 350 survivors of BC, diagnosed ≥5 years ago who received chemotherapy and/or radiotherapy, and 350 matched controls of the same age, without a history of cancer. A second measurement will be performed ≥11 years after diagnosis. The primary outcome is left ventricular systolic cardiac dysfunction, defined as LVEF<54%, measured by echocardiography. Secondary outcomes will be the rate of deterioration of cardiac function by change in LVEF and diagnosed cardiovascular diseases and medication as obtained from GP-files.

Results:

Results will include the prevalence of systolic dysfunction and cardiovascular diseases in BC survivors. Furthermore, we aim to provide insight whether treatment of BC is an independent risk factor for long-term cardiac dysfunction. The study is in progress and results will follow.

Conclusions:

This study will explore if cardiac function deteriorates at a faster rate for women treated for BC and which clinical and lifestyle factors contribute to this process.

Points for discussion:

Challenges in recruitment of participants after the long interval between the 2 studies

Should there be a guideline for monitoring and/or preventing cardiotoxicity for long-term survivors of BC?

Should we regularly screen cardiac function in women treated for breast cancer?

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