Anecita P. Fadol

Psychometric Testing of the MDASI-HF: A Symptom Assessment Instrument for Patients With Cancer and Concurrent Heart Failure

BACKGROUND The debilitating symptoms of cancer and heart failure (HF) can adversely affect the patients quality of life. This study evaluated the psychometric properties of the MD Anderson Symptom Inventory--Heart Failure (MDASI-HF), a 27-item self-report assessment instrument for patients with cancer and concurrent HF. METHODS AND RESULTS Psychometric testing used data from 156 patients (age 63.3 +/- 13.2 years, 56% male) with a diagnosis of cancer and HF receiving care in a major cancer center. Reliability of the MDASI-HF for the 13 symptoms (alpha = 0.89), 8 HF-specific items (alpha = 0.83), and interference items (alpha = 0.92) was high. Criterion-related validity with the Eastern Cooperative Oncology Group performance scale (r = 0.63) and the New York Heart Association classification (r = 0.65) were statistically significant, P = .01. Construct validity supported two constructs for the additional HF specific items: covert HF factor and overt HF factor. CONCLUSION The MDASI-HF is a valid and reliable instrument for symptom assessment in patients with cancer and HF. This instrument can be used to identify symptom occurrence and enhance the providers understanding of the prevalence and severity of symptoms from the patients perspective.

Withdrawal of beta blockers and ACE inhibitors in chemotherapy induced heart failure leads to severe adverse cardiovascular events

Withdrawal of Beta Blockers and ACE Inhibitors in Chemotherapy Induced Heart Failure Leads to Severe Adverse Cardiovascular Events Daniel J. Lenihan, Ann Tong, Myrshia Woods, S. Wamique Yusuf, Anecita Fadol, Shobha Pai, Jessica Tristan, Roger Campana, Mary Vooletich, Gregory Giesler, Vijay G. Divakaran, Joseph Swafford, Michael S. Ewer, Jean-Bernard Durand1—Cardiology, University of Texas M.D. Anderson Cancer Center, Houston, TX

Management of Chemotherapy-Induced Left Ventricular Dysfunction and Heart Failure in Patients With Cancer While Undergoing Cancer Treatment: The MD Anderson Practice

Chemotherapy-induced cardiotoxicity resulting in heart failure (HF) is one of the most dreaded complications of cancer therapy that can significantly impact morbidity and mortality. With a high prevalence of cardiovascular disease in cancer patients, the risk of developing HF is significantly increased. A new discipline of Onco-Cardiology has evolved to address the cardiovascular needs of patients with cancer, however, there is limited evidence-based data to guide clinical decision-making in the management of the cardiovascular complications of cancer therapy. The department of cardiology at MD Anderson Cancer Center initiated the MD Anderson Practice (MAP) project and developed algorithms to guide the management of the cardiovascular complications of cancer therapy. For chemotherapy-induced HF, we initiated the Heart Success Program (HSP), a patient-centered program that promotes interdisciplinary collaboration for the management of concurrent HF resulting from chemotherapy-induced cardiotoxicity. After one year of HSP implementation, compliance with the Center for Medicare and Medicaid Services HF core measures has significantly improved. The measurement of LVEF and initiation of recommended pharmacologic therapy for HF (angiotensin converting enzyme inhibitor [ACE-I] or angiotensin receptor blocker for ACE-I intolerant patients) has improved to 100%; provision of discharge instruction has improved from 50 to 94%; and the 30-day hospital readmission rate decreased from 40 to 27%. This article will describe the MD Anderson Practice in the management of chemotherapy-induced cardiomyopathy and HF in cancer patients through the HSP. The novelty of the HSP has raised clinician’s awareness of the magnitude of the clinical problem of HF in cancer and the

Recovery of chemotherapy-induced left ventricular dysfunction in cancer survivors.

136 Background: Chemotherapy-induced left ventricular dysfunction (CILVD) leading to heart failure (HF) is a clinical problem of emerging importance particularly with the 14.5 million cancer survivors who are alive in the United States today, and projected to increase to almost 19 million in 2024. Many of these survivors have received cardiotoxic anticancer agents such as anthracycline and trastuzumab. Research showed that those exposed to anthracyclines are expected to have some degree of cardiac dysfunction 10 to 20 years after treatment and 5% of those patients will develop overt HF. This pilot study investigated whether cancer survivors with CILVD who achieved recovery of cardiac function will maintain their left ventricular ejection fraction (LVEF) if HF medications were discontinued. METHODS We conducted a prospective pilot study on 20 cancer survivors with history of CILVD with recovered cardiac function. HF medications were weaned off in a stepwise process per protocol. Cardiac function was monitored with LVEF measurement per echocardiography and cardiac biomarkers performed at baseline, 2, 4 and 6 months. Patients monitor their heart rate, blood pressure, and symptoms and reported changes based on set parameters. RESULTS Cancer survivors who maintained their LVEF after discontinuation of HF medications were younger (mean age 47.9 years SD+12.0), 65% female, 55% breast cancer survivors, with no history ofischemic heart disease, hypertension, diabetes mellitus and cardiac dysrhythmias. Chemotherapeutic agents (mean dose) used in the treatment of these patients include doxorubicin (363 mg/m2), epirubicin (527mg /m2), cyclophosphamide (5062 mg), and trastuzumab (6317 mg). There was no significant change from baseline measurements of LVEF and global longitudinal strain (GLS) of 55.1% (± 3.7) GLS of -18.3% (± 2.7) prior to weaning the HF medication to 56% (± 1.6) GLS of -18.2% (± 2.3). after complete withdrawal of HF medications. CONCLUSIONS With the increasing number of young cancer survivors, CILVD may become a frequent clinical issue. Clearly, there is a need to examine the safety of withdrawing HF medications in cancer survivors with CILVD and if lifelong therapy with HF medications is necessary.