Prevalence of Anthracycline-Induced Cardiotoxicity and Associated Factors among Patients with Breast Cancer Attending Ocean Road Cancer Institute in Tanzania

Abstract

Background: Anthracycline chemotherapy is the cornerstone of breast cancer treatment. Anthracyclines possess potent anti-tumor properties, and their benefits are confirmed by a considerable body of evidence. Their efficacy is undermined by dose-dependent cardiotoxicity that mandates close monitoring of cardiac function. However, there is a paucity of data regarding the prevalence of anthracycline-induced cardiotoxicity and associated factors among patients with breast cancer. Study Objective: This study aimed to determine the prevalence of Anthracycline induced cardiotoxicity (AIC) and associated factors among patients with breast cancer undergoing treatment with anthracycline-containing regimens at ORCI. Methodology: A cross-sectional study was conducted at ORCI among patients with histologically confirmed breast cancer on their last cycle of anthracycline chemotherapy based regimen from Dec 2020 through June 2021. A convenience sampling technique was used. To assess anthracycline-induced cardiotoxicity, a 2D Echocardiogram was used as the main assessment tool, breast cancer patients who were on their last cycle of anthracycline were recruited as per eligibility criteria and their demographic and clinical characteristics were noted down on a prepared questionnaire. Data analysis was done using SPSS version 23 IBM. Categorical variables were summarized using frequencies while measures of central location and dispersion were used to summarize continuous variables. Logistic regression was conducted to determine factors associated with AIC. Factors with a p-value of less than 0.05 during bivariate analysis were included in the multivariate analysis. Factors with a p-value less than (0.05) were considered significant. Results: A total of 118 breast cancer patients on anthracycline-based regimens from December 2020 through June 2021 at Ocean Road Cancer Institute were enrolled in the study. The median age of study participants was 51.5 years. 99% (117) were females. Of the enrolled participants, 9.3% (11) were confirmed to have AIC through ECHO. Nearly all 96% (113) received an AC regimen; the mean cumulative anthracycline dose was 397mg/m2 (SD 43.5). Fourteen percent (16) of the patients had a body mass index > 25; 3.4% (4) of the patients had cardiac symptoms. Upon multivariable analysis, a body mass index greater than 25 (aOR=6.09 95% CI 1.17-31.81) was associated with an increased risk of developing AIC. Cumulative anthracycline dose ≤350 (aOR=0.08; 95% CI 0.03-0.19) and not having cardiac symptoms (aOR=0.01; 95% CI 0.01-0.19) were protective factors from AIC. Conclusion: This study demonstrated a prevalence of anthracycline-induced cardiotoxicity and associated factors among patients with breast cancer to be 9.3% within three months of completion of an anthracycline-based chemotherapy regimen. This data is similar to other studies done internationally. It also showed that the presence of cardiac symptoms, high BMI, and low cumulative anthracycline dose had an association with AIC.