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Cardiac assessment in Australian patients receiving (neo)adjuvant trastuzumab for HER2-positive early breast cancer: a population-based study

  • Epidemiology
  • Published:
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Abstract

Purpose

Cardiac function assessment is important for detecting and managing trastuzumab-associated cardiotoxicity. Our study estimates rates and predictors of cardiac assessment among patients receiving trastuzumab for HER2-positive early breast cancer (HER2+EBC) in Australia.

Methods

We conducted a retrospective cohort study of Australians initiating (neo)adjuvant trastuzumab for HER2+EBC between 1 January 2015 and 15 April 2019. We used administrative claims to determine the number of patients receiving guideline-recommended assessment, i.e. evidence of baseline cardiac assessment (between 120 days before and 30 days after trastuzumab initiation) and regular on-treatment cardiac assessments (at least every 120 days). We examined factors associated with baseline and regular on-treatment cardiac assessment.

Results

Our study includes 5621 patients (median age 56 years), of whom 4984 (88.7%) had a baseline cardiac function test. Among 4280 patients with at least 12 months of follow-up, 2702 (63.1%) had guideline-recommended cardiac assessment. Rates of guideline-recommended assessment increased with later year of diagnosis (60.9% in 2015 vs 68.3% in 2018, OR 1.34, 95% CI 1.06–1.69). Patients with higher baseline comorbidities and greater socioeconomic disadvantage were less likely to have guideline-recommended cardiac assessment. Cardiac assessment practices varied by State/Territory. There was no association between baseline cardiac risk or anthracycline use and the likelihood of receiving guideline-recommended cardiac assessment.

Conclusion

The majority of patients receiving (neo)adjuvant trastuzumab had guideline-recommended baseline and on-treatment cardiac assessment. Variations in cardiac assessment predominantly related to system-level factors, such as year of diagnosis and geography, rather than individual patient factors.

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Data availability

We thank the Australian Government Services Australia for providing the data. Access to the datasets analysed during the current study is not permitted without the express permission of the approving human research ethics committees and data custodians.

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Funding

This research is supported by the National Health and Medical Research Council Centre of Research Excellence in Medicines Intelligence (ID: 1196900). MT is supported by an Australian Government Research Training Program Scholarship, a National Health and Medical Research Council Postgraduate Research Scholarship (ID: 1151479), a National Breast Cancer Foundation Postgraduate Scholarship Top-Up (ID: DS-18–01), and a Translational Cancer Research Network Clinical PhD Scholarship Top-Up award, supported by the Cancer Institute NSW. AS is supported by a National Health and Medical Research Council Early Career Fellowship (ID: 1158763).

Author information

Authors and Affiliations

  1. Centre for Big Data Research in Health, University of New South Wales, Level 2, AGSM Building (G27), Sydney, NSW, 2052, Australia

    Monica Tang, Andrea L. Schaffer, Benjamin Daniels & Sallie-Anne Pearson

  2. NHMRC Clinical Trials Centre, University of Sydney, Levels 4-6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia

    Belinda E. Kiely, Chee K. Lee & Robert J. Simes

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  1. Monica Tang
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Contributions

MT, AS and SAP were responsible for conceiving of and designing the study. MT and AS were responsible for statistical analysis. MT, AS, BEK, BD, RJS, CKL and SAP were responsible for data analysis and interpretation. MT was responsible for writing the manuscript. MT, AS, BEK, BD, RJS, CKL and SAP were responsible for editing and reviewing the manuscript.

Corresponding author

Correspondence to Monica Tang.

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Conflict of interest

Belinda E. Kiely reports funding from Roche and TEVA for participating in advisory boards; speakers fees from Roche and Novartis; and travel/conference expenses from Roche. Chee K. Lee reports grants from AstraZeneca and personal fees from AstraZeneca, Novartis, Pfizer, Roche, Boehringer Ingelhein, Takeda, outside of the submitted work. Sallie-Anne Pearson is a member of the Drug Utilisation Sub Committee of the Pharmaceutical Benefits Advisory Committee. The views expressed in this paper do not represent those of the Committee. The Centre for Big Data Research in Health, UNSW Sydney has received funding from AbbVie Australia to conduct research, unrelated to the present study. AbbVie did not have any knowledge of, or involvement in, the present study. All remaining authors have declared no conflicts of interest relevant to the submitted work.

Ethical approval

This study was approved by the New South Wales Population and Health Services Research Ethics Committee (Approval Number: 2010/02/213). The Ethics Committee granted a waiver of the usual requirement for the consent of the individual to the use of their health information in a research project, in line with the Guidelines approved under Sect. 95/95A of the Privacy Act 1988. The study was performed in accordance with the Declaration of Helsinki.

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Tang, M., Schaffer, A.L., Kiely, B.E. et al. Cardiac assessment in Australian patients receiving (neo)adjuvant trastuzumab for HER2-positive early breast cancer: a population-based study. Breast Cancer Res Treat 187, 893–902 (2021). https://doi.org/10.1007/s10549-021-06135-5

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