Cardio-oncology Clinical Assessment and Screening in Patients Undergoing High Toxicity Chemotherapy: A Retrospective Cohort Study

Abstract

Objective: To describe the clinical characteristics and cardio-oncological assessment in patients undertaking highly toxic chemotherapy and/or chest radiotherapy in a high-complexity hospital.

Methods: A single-center retrospective cohort study was carried out between January 1st, 2017 and December 31st, 2019. The medical records of patients with solid or hematological neoplasms were reviewed. Descriptive information was obtained on demographic characteristics, chemotherapeutic agents, pre-chemotherapy cardiovascular (CV) evaluation, and CV outcomes. The risk of complications was assessed using the Mayo Clinic risk score.

Results: A total of 499 patients were included, the most common neoplasm was non-Hodgkin's lymphoma (21.6%), followed by breast cancer (19.4%). A very high risk of cardiotoxicity was present in 44.1% and 90% were not evaluated by cardiology. Pre-chemotherapy echocardiography was obtained in 65%, but only 19.4% underwent echocardiographic control after finishing chemotherapy. The most frequent CV outcomes were chemotherapy-related systolic dysfunction (4.4%) and rhythm disturbances (2.8%), with atrial fibrillation and atrial flutter being the most frequent arrhythmias.

Conclusion: Despite the recognized CV toxicity of chemotherapeutic drugs, the majority of patients receiving highly toxic regimens at high risk of CV complications are not previously evaluated by a cardiologist and the CV workup was not routinely used in our study. The implementation of cardio-oncology programs will facilitate the identification of high-risk patients, aiming to detect and treat complications early.

Keywords: cardio-oncology; cardiotoxicity; chemotherapy; hematological malignancies; solid tumors.

Figure 1. Recruitment of 499 patients with a diagnosis of solid or hematological neoplasia undergoing chemotherapy and/or chest radiotherapy.