P1-10-01: Utility of Routine Cardiac Ejection Fraction (CEF) Measurement Prior to Anthracycline-Based Chemotherapy (ABC): A Study of 466 Patients with Early-Stage Her2-Negative Invasive Breast Cancer.

Abstract

Abstract Background: Despite the lack of evidence to support its utility, routine CEF measurement prior to ABC is a common practice in the community, required in most US clinical trials, endorsed by the American Heart Association and American College of Cardiology, and appears on Food Drug Administration-approved labeling guidelines. Objectives: We determined the frequency of the following events in newly diagnosed invasive breast cancer patients: a) CEF measurement prior to ABC; b) asymptomatic left ventricular dysfunction; c) modification in initial treatment strategy as a result of CEF measurement; d) development of congestive heart failure (CHF) after ABC. Methods: From our cancer registry, we obtained a list of all female patients with newly diagnosed stage I-III breast cancer who were treated with chemotherapy as part of initial therapy at our institution in 2000–2010 (N=562). We excluded those with prior CHF, ABC, and those who had Her2-positive disease (n=66). CEF <50% was considered low. CHF risk factors including coronary heart disease, cigarette smoking, hypertension, obesity, and diabetes mellitus were collected. Results: We included 496 patients with the following stage distribution: I (22%), II (54%), and III (24%). The mean age was 53 years (SD±11; range 25–88). In 30 (7%) patients, ABC was considered inappropriate by the physician provider due to poor performance status, co-morbidities, and physician or patient preference. Of the 466 patients considered for ABC, CEF was measured in 241 (52%) patients before chemotherapy. In the latter group, only 1 (0.4%) patient was found to have asymptomatic left ventricular dysfunction with CEF of 48%. Among patients considered for ABC, 10 (2%) did not receive ABC for the following reasons: low or borderline CEF (2), patient preference (3), co-morbidities (2), and randomization to non-ABC in clinical trials (3). After a mean follow up 57 months (SD±34), only 3 of 456 (0.7%) patients who received ABC developed CHF. Two had normal CEF prior to treatment while the other did not have CEF measured. The practice of CEF measurement prior to ABC varied among physician providers, ranging from 23% to 67% (mean/SD 47%±15%). Those who had CEF measured before chemotherapy were older (55 vs. 50 years; P <0.001) and had more CHF risk factors (1.3 vs. 0.9; P <0.001). Conclusions: At our institution, routine CEF measurement prior to ABC as initial therapy for early-stage Her2-negative invasive breast cancer patients is a common though not uniform practice. Asymptomatic left ventricular dysfunction is rarely detected and generally mild. Our findings do not support the utility of routine CEF measurement in this population and challenge current practice and guidelines. Potential cost implications to our health care system can be substantial. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-10-01.