A Better Understanding of Cardiac Toxicity in Breast Cancer

While there have been some outstanding treatment advancements for breast cancer, many survivors of the disease end up facing cardiac morbidity and mortality as a result of the treatments that they received.

Prior research has shown that anthracycline-based chemotherapy can be particularly damaging to patients’ cardiovascular function in the long run.

Research in this field is still young, and there are plenty of unanswered questions, such as what happens leading up to cardiac toxicity in these patients. In an attempt to answer this question and more, a team of researchers are conducting a trial called UPBEAT: a prospective cardio-oncology study.

At the 2019 ASCO Annual Meeting, Oncology Nursing News sat down with study author Kerryn Reding, PhD, MPH, RN, an associate professor of the School of Nursing at the University of Washington and member at the Fred Hutchinson Cancer Research Center.

Oncology Nursing News: Can you discuss the progress made in breast cancer in recent years, and how that progress has been offset by an increase in cancer-therapy morbidity and mortality?

Reding: Great advances have been made for treatment of breast cancer that have led to great survival rates for women with stage I through III breast cancer, but those same women often experience late effects, or [adverse events] from their treatment. Those include things like fatigue, exercise intolerance, and an increased risk of cardiovascular disease. We see that about a third of women, after treatment ends, are still living with fatigue and a reduced exercise capacity. That puts them at a lower quality of life, and they also experience lower ability to perform their activities of daily living.

What was the goal of the UPBEAT cardio-oncology study? What was the goal of the trial, and what were the methods that were used?

This is an ongoing clinical, prospective study. It is aimed to understand better what are the effects of the breast cancer treatment, particularly on the cardiovascular system. There are cardiac MRIs that are taking place that will have a better ability to detect what changes are happening in the heart so we can learn more about the cardiac dysfunction associated with cancer treatment, and then we're also collecting data on fatigue, as well as exercise capacity through a cardiopulmonary exercise task. It really is one of the most comprehensive investigations of breast cancer patients.

One of the areas that it stands out is that it is collecting these data as women are diagnosed, so prior to any treatment that is given to the women. And then, they are also followed over time.

What are some of the specific treatments that the study is looking at?

This would be for women with stage I through III breast cancer who are receiving any type of chemotherapy, and it's focused particularly on anthracyclines, so it's going to be recruiting women who have any treatment, but also oversampling women with anthracycline-based treatment, as well as radiation. It will be able to look at the effects of both of those. One of the other strengths of this study is that it will be collecting medical records as the patients go through, so prospectively, rather than looking later, retrospectively, to try to deduce what treatments a woman received. We think that the ascertainment of treatment data will be highly valid.

The women will be followed for 2 years with the questionnaires, the cardiopulmonary exercise tests, and the cardiac MRIs. Then they'll be followed for an additional 7 years to look at the occurrence of cardiovascular events in the population.

How many patients are accrued, and how many do you hope to accrue?

We hope to accrue 1,000 patients. We're currently at 181 patients. We have a ways to go, and we have more and more sites that, when they hear about it, are onboarding for our clinical study. We're continuing to bring on clinic sites, and so we’re hoping to grow the numbers that we recruit each month.

When do you expect initial results?

I would expect that within 4 years we would have some initial results that will tell patients about what maybe happened in the first 3 months of their treatment. Then, the results that take longer to accrue, those results will be later.

What should patients know about this trial?

One of the things that we often stress is that this is a trial that is going to help the field to understand more about the late effects of breast cancer treatments. While the patients will not be getting back their individual results, they'll be contributing to that greater scientific understanding so that we can go on to have a better understanding to inform patient care in the future.

Read more:

Exercise During Adjuvant Breast Cancer Treatment Improves Cardiovascular Function

Nurses Should Explore the Value of Cardiac Monitoring Among Younger Breast Cancer Survivors