Only a third of older breast cancer patients saw a cardiologist within 90 days of developing heart problems, in a study presented at the American Heart Association’s Quality of Care and Outcomes Research 2014 Scientific Sessions.
Breast cancer patients with heart problems who saw a cardiologist were more likely to receive standard heart failure therapy than those who did not see a heart specialist, the study found.
“The majority of older women who develop heart problems after their breast cancer therapy aren’t treated by a cardiologist, and they had lower quality of care,” said Jersey Chen, M.D., M.P.H., lead author of the study and a research scientist and cardiologist at Kaiser Permanente in Rockville, Maryland. “This suggests that this is an important area for oncologists and cardiologists to collaborate.”
Researchers used Medicare data to identify women older than 65 who were diagnosed in 2000-09 with stage I-III breast cancer and received cancer treatments previously linked to heart problems. They tracked which patients developed cardiomyopathy or heart failure.
Cardiomyopathy is when the heart becomes weak and has trouble pumping blood. Heart failure occurs when the weakened heart causes symptoms such as fatigue and shortness of breath.
Among breast cancer patients identified, 1,028 developed heart problems within three years of receiving chemotherapy drugs called anthracyclines or a targeted therapy called trastuzumab. Thirty-four percent of them saw a cardiologist within 90 days of their heart diagnosis. Women with heart failure after cancer treatment were more likely to be treated with standard medications if seen by a cardiologist compared to those who did not see a cardiologist, said researchers.
“The bottom line is, if you have breast cancer and you’re treated with anthracyclines or trastuzumab, you should know they have side effects,” Chen said. “And if you have symptoms of heart problems like shortness of breath or swelling in the feet or legs, seek attention quickly, preferably with doctors familiar and comfortable with treating heart failure after cancer therapy.”
“Many cancer patients who develop heart failure or cardiomyopathy aren’t getting the necessary medications, regardless of whether they’re seen by cardiologists,” he said. “So there is work to be done to improve care for all women with cardiac complications after cancer therapy.”
Using Medicare prescription plan data from 2006-11, researchers found that 60 percent of patients with heart problems who saw a cardiologist received ACE inhibitors or angiotensin receptor blockers, versus 44 percent of those who didn’t. For beta-blockers, the figures were 40 percent versus 24 percent. Those drugs are the mainstay of treatment for heart failure, Chen said.
People with other cancers — especially if they are older or have many other health problems — should also be watchful for heart symptoms if they receive anthracyclines or trastuzumab, Chen said.
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