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Positive spillover effects of prescribing requirements: increased cardiac testing in patients treated with trastuzumab for HER2+ metastatic breast cancer
Author(s) -
Lu C. Y.,
Srasuebkul P.,
Drew A. K.,
Ward R. L.,
Pearson S.A.
Publication year - 2012
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2011.02604.x
Subject(s) - medicine , trastuzumab , cardiotoxicity , metastatic breast cancer , breast cancer , oncology , cardiac function curve , confidence interval , cancer , cardiology , chemotherapy , heart failure
Background Cardiotoxicity is a concern in patients on trastuzumab therapy, and cardiac function assessment is a recommended practice. In 2006, trastuzumab was publically subsidised for human epidermal growth factor receptor‐2 early stage breast cancer with a requirement for cardiac testing prior to and during treatment. Aim To investigate the spillover effects of this requirement on testing rates in metastatic patients treated with trastuzumab where no monitoring requirements are applied. Methods We examined cardiac testing (echocardiography or multiple‐gated acquisition scan) in 3779 women with metastatic breast cancer receiving trastuzumab between D ecember 2001 and F ebruary 2010 and used interrupted time‐series analyses to estimate changes in testing rates. The main outcome measures were the proportion of eligible patients, by quarter, receiving a cardiac function test pretreatment and during trastuzumab therapy. Results Only 21% of women had a cardiac function test pretreatment, and 47% were tested at some point during the first year of trastuzumab therapy. The introduction of mandatory cardiac testing for early breast cancer was associated with an immediate 8% increase (95% confidence interval, 2–14%) in pretreatment cardiac testing and an immediate 7% increase (95% confidence interval, 4–10%) in testing during therapy in metastatic patients. Testing rates during therapy increased steadily from early 2005, coinciding with the release of interim results from several trastuzumab trials reporting cardiac‐safety outcomes. Conclusion The introduction of mandatory cardiac testing for early stage disease spilled over to the metastatic setting. While deviation from guidelines may be warranted in some cases, this study suggests underutilisation of cardiac testing among patients treated with trastuzumab in the metastatic setting.