Poster Presentation 2025 National Cancer Survivorship Conference

Pharmacist led optimisation of cardiac surveillance post anthracyclines for patients with haematological malignancy  (#78)

Kristina Josevska 1 , Thao Dao 1 , Berenice Sheridan 1 , Angelene Jesurajah 1 , Tu Do 1 , Samuel Shephard 1 , Tegan L Dunmall 2 , Sean Tan 3 4 , Satish Ramkumar 4 5 , Pasquale L Fedele 2 3 , Amanda Tey 1
  1. Pharmacy Department , Monash Health, Clayton, Victoria, Australia
  2. Department of Clinical Haematology, Monash Health, Clayton, Victoria, Australia
  3. School of Clinical Sciences, Monash Health , Clayton, Victoria, Australia
  4. Victorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia
  5. Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia

Background: Cardiotoxicity is a well-established complication of anthracycline therapy. Transthoracic echocardiogram (TTE) within a year of treatment completion is recommended by the European Society of Cardiology1. Early detection of cardiotoxicity may facilitate recovery2.  Anecdotally uptake of recommendations is low, thus we sought to define this and implement changes to improve monitoring compliance.  

Aim: To assess compliance with cardiac monitoring recommendations in patients receiving anthracyclines for haematological malignancy. To assess whether pharmacist led screening improves monitoring compliance.  

Method: Haematology patients completing anthracycline treatment 1/8/23-31/7/24 were retrospectively identified from dispensing records. Demographic and treatment data were collected from the electronic medical record. The primary outcome was reporting of TTE results within 12 months of anthracycline completion.  

Results: 106 patients were identified with a median age (interquartile range (IQR)) of 60 (48-70) years. The most commonly used regimens were CHOP-based (n=60;57%), ABVD (n=22;21%) and 7+3-idarubicin (n=10;9%). Median baseline left ventricular ejection fraction (LVEF) (IQR) was 64% (60-69). Post- treatment TTE was reported/scheduled within 12 months of completion in 35 patients (33%). Median time to TTE in these patients (IQR) was 5  (3.0-8.1) months and median change in LVEF on 29 reports was -7% (range -30 - +7). Six patients (21%) had LVEF reduction of 10% or more from baseline to a final LVEF <53%3. 

Discussion: Two-thirds of patients identified did not have a post-treatment TTE completed within 12 months, compliance with the ESC guideline was low. These pharmacist identified patients will be communicated to treating physicians to facilitate TTE request. Cardio-oncology education has been conducted and a guideline is in development to inform practice. Prospective monthly pharmacist audits have been implemented to notify haematologists of patients requiring post-anthracycline TTE.  

Conclusion: This audit has identified low uptake of timely post-anthracycline cardiac monitoring and has identified a large scope for pharmacist led monitoring for cardiac toxicity.

  1. Lyon AR, López-Fernández T, Couch LS, et al: 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 43:4229-4361, 2022
  2. Cardinale D, Colombo A, Bacchiani G, et al: Early Detection of Anthracycline Cardiotoxicity and Improvement With Heart Failure Therapy. Circulation 131:1981-1988, 2015
  3. Eviq.org.au: 2004 Cardiac toxicity associated with anthracyclines [internet] Available at: : https://www.eviq.org.au/clinical-resources/side-effect-and-toxicity-management/cardiovascular/1667-cardiac-toxicity-associated-with-anthracyclin.