Outcome of 5-years active cardiological management of oncohematological patients on targeted therapy

Abstract

Abstract Background The overall survival of oncohematological patients (pts) depends not only on the severity of the cancer, the anticancer therapy used and the comorbidity of the pts. The most important role in the management of these pts is played by the supervision of a cardiologist. Purpose To assess the effect of active cardiac management on the overall survival of oncohematological pts on targeted therapy with ibrutinib. Methods We examined and observed in dynamics for 5 years 217 pts with chronic lymphocytic leukemia (CLL), constantly receiving ibrutinib, inducing arterial hypertension (AH) and atrial fibrillation (AF) in a part of the pts. All pts underwent echocardiography (Echo), 24-hour Holter ECG monitoring (HM), assessment of comorbidity using the Charlson index and screening of fragility using the G8 questionnaire. Everyday measurement of blood pressure, heart rate in the morning and in the evening with keeping a measurement diary was recommended for all pts, but 89 pts were performed, who constantly contacted us remotely using instant messengers and formed an active cardiac management (ACM) group. Results We studied the overall survival of pts with CLL receiving targeted therapy with ibrutinib, depending on cardiac monitoring, starting from the first visit. The age of pts in the ACM group (n=89) and in other pts (n=138) did not differ and amounted to 66.0 (60.0–70.0) years and 66.0 (59.0–74.0) years respectively. The number of men and women in the groups was comparable. In the ACM group, there were significantly more pts with AH - 86.5% and with AF - 42.7% compared to 50.4% with AH and 15.9% with AF in the rest of the pts (p<0.0001 in both cases) and a comparable number of pts with coronary artery disease. According to the screening HM, there were more pts with short AF episodes in the ACM group - 31.4% versus 8.0% in the rest of the pts (p<0.0001). Accordingly, the number of pts who received cardiological treatment in the ACM group was 87.6%, in the group of other pts - 53.6% (p<0.0001). Echo parameters did not differ in the groups. Indicators that significantly affect survival in the general group (Charlson index, scores of the G8 questionnaire) did not differ significantly in the ACM group and in other pts with CLL. The groups also did not differ in hematological status and the number of cases of second tumors. At the same time, despite a significantly more pronounced cardiac comorbidity, oncohematological pts under active cardiac monitoring, including continuous remote monitoring, demonstrated better survival compared to other pts (p<0.0001). Conclusions Conducting active cardiac management, including constant remote observation, allows achieving higher overall survival rates of hematological cancer patients, despite a more severe cardiac status compared to other pts under periodic supervision of a cardiologist. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): no founding sources