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.