Selective cardiac surveillance in patients with gynecologic cancer undergoing treatment with pegylated liposomal doxorubicin (PLD)

C. L. Kushnir, A. M. Angarita, L. J. Havrilesky, S. Thompson, D. Spahlinger, A. K. Sinno, E. J. Tanner, A. A. Secord, K. L. Roche, Rebecca Stone, Amanda Nickles Nickles Fader

Research output: Contribution to journalArticle

Abstract

Objective The study objective was to examine the safety and cost savings of selective cardiac surveillance (CS) during treatment with pegylated liposomal doxorubicin (PLD). Methods A retrospective, dual institution study of women receiving PLD for the treatment of a gynecologic malignancy was performed. The study period was 2002-2014. At both institutions, a selective strategy for CS was implemented in which only high-risk women with a cardiac history or with symptoms suggestive of cardiac toxicity during PLD treatment underwent a cardiac evaluation. Patient demographics, clinical and treatment history were evaluated. Cost analyses were performed utilizing professional/technical fee rates for echocardiogram and multi-gated acquisition scan for each state. Results PLD was administered in 184 women. The mean patient age was 62.7 years, and 79% were treated for recurrent ovarian or peritoneal carcinoma. The median cumulative administered dose of PLD was 300 mg/m2; 24 received > 550 mg/m2. The median follow-up time was 20 months. Of the 184 patients, the majority (n = 157, 85.3%) did not undergo either an initial cardiac evaluation or surveillance during or post-PLD treatment. Fifty-three patients considered high risk for anthracycline-induced cardiotoxicity underwent CS. Only three patients (1.6%) in the entire cohort developed CHF that was possibly related to PLD treatment; all had significant pre-existing cardiac risk factors. Selective instead of routine use of CS in the study population resulted in a cost savings of $182,552.28. Conclusion Utilizing cardiac surveillance in select women undergoing PLD treatment for gynecologic malignancies resulted in significant health care cost savings without adversely impacting clinical outcomes.

Original languageEnglish (US)
Pages (from-to)503-507
Number of pages5
JournalGynecologic Oncology
Volume137
Issue number3
DOIs
StatePublished - Jun 1 2015

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Cost Savings
Neoplasms
Therapeutics
History
Fees and Charges
liposomal doxorubicin
Anthracyclines
Health Care Costs
Demography
Carcinoma
Safety
Costs and Cost Analysis
Population
Cardiotoxicity

Keywords

  • Cardiotoxicity
  • Echocardiogram
  • Gynecologic malignancy
  • Pegylated liposomal doxorubicin
  • Surveillance

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology
  • Medicine(all)

Cite this

Selective cardiac surveillance in patients with gynecologic cancer undergoing treatment with pegylated liposomal doxorubicin (PLD). / Kushnir, C. L.; Angarita, A. M.; Havrilesky, L. J.; Thompson, S.; Spahlinger, D.; Sinno, A. K.; Tanner, E. J.; Secord, A. A.; Roche, K. L.; Stone, Rebecca; Nickles Fader, Amanda Nickles.

In: Gynecologic Oncology, Vol. 137, No. 3, 01.06.2015, p. 503-507.

Research output: Contribution to journalArticle

Kushnir, CL, Angarita, AM, Havrilesky, LJ, Thompson, S, Spahlinger, D, Sinno, AK, Tanner, EJ, Secord, AA, Roche, KL, Stone, R & Nickles Fader, AN 2015, 'Selective cardiac surveillance in patients with gynecologic cancer undergoing treatment with pegylated liposomal doxorubicin (PLD)', Gynecologic Oncology, vol. 137, no. 3, pp. 503-507. https://doi.org/10.1016/j.ygyno.2015.02.020
Kushnir, C. L. ; Angarita, A. M. ; Havrilesky, L. J. ; Thompson, S. ; Spahlinger, D. ; Sinno, A. K. ; Tanner, E. J. ; Secord, A. A. ; Roche, K. L. ; Stone, Rebecca ; Nickles Fader, Amanda Nickles. / Selective cardiac surveillance in patients with gynecologic cancer undergoing treatment with pegylated liposomal doxorubicin (PLD). In: Gynecologic Oncology. 2015 ; Vol. 137, No. 3. pp. 503-507.
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abstract = "Objective The study objective was to examine the safety and cost savings of selective cardiac surveillance (CS) during treatment with pegylated liposomal doxorubicin (PLD). Methods A retrospective, dual institution study of women receiving PLD for the treatment of a gynecologic malignancy was performed. The study period was 2002-2014. At both institutions, a selective strategy for CS was implemented in which only high-risk women with a cardiac history or with symptoms suggestive of cardiac toxicity during PLD treatment underwent a cardiac evaluation. Patient demographics, clinical and treatment history were evaluated. Cost analyses were performed utilizing professional/technical fee rates for echocardiogram and multi-gated acquisition scan for each state. Results PLD was administered in 184 women. The mean patient age was 62.7 years, and 79{\%} were treated for recurrent ovarian or peritoneal carcinoma. The median cumulative administered dose of PLD was 300 mg/m2; 24 received > 550 mg/m2. The median follow-up time was 20 months. Of the 184 patients, the majority (n = 157, 85.3{\%}) did not undergo either an initial cardiac evaluation or surveillance during or post-PLD treatment. Fifty-three patients considered high risk for anthracycline-induced cardiotoxicity underwent CS. Only three patients (1.6{\%}) in the entire cohort developed CHF that was possibly related to PLD treatment; all had significant pre-existing cardiac risk factors. Selective instead of routine use of CS in the study population resulted in a cost savings of $182,552.28. Conclusion Utilizing cardiac surveillance in select women undergoing PLD treatment for gynecologic malignancies resulted in significant health care cost savings without adversely impacting clinical outcomes.",
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AU - Angarita, A. M.

AU - Havrilesky, L. J.

AU - Thompson, S.

AU - Spahlinger, D.

AU - Sinno, A. K.

AU - Tanner, E. J.

AU - Secord, A. A.

AU - Roche, K. L.

AU - Stone, Rebecca

AU - Nickles Fader, Amanda Nickles

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N2 - Objective The study objective was to examine the safety and cost savings of selective cardiac surveillance (CS) during treatment with pegylated liposomal doxorubicin (PLD). Methods A retrospective, dual institution study of women receiving PLD for the treatment of a gynecologic malignancy was performed. The study period was 2002-2014. At both institutions, a selective strategy for CS was implemented in which only high-risk women with a cardiac history or with symptoms suggestive of cardiac toxicity during PLD treatment underwent a cardiac evaluation. Patient demographics, clinical and treatment history were evaluated. Cost analyses were performed utilizing professional/technical fee rates for echocardiogram and multi-gated acquisition scan for each state. Results PLD was administered in 184 women. The mean patient age was 62.7 years, and 79% were treated for recurrent ovarian or peritoneal carcinoma. The median cumulative administered dose of PLD was 300 mg/m2; 24 received > 550 mg/m2. The median follow-up time was 20 months. Of the 184 patients, the majority (n = 157, 85.3%) did not undergo either an initial cardiac evaluation or surveillance during or post-PLD treatment. Fifty-three patients considered high risk for anthracycline-induced cardiotoxicity underwent CS. Only three patients (1.6%) in the entire cohort developed CHF that was possibly related to PLD treatment; all had significant pre-existing cardiac risk factors. Selective instead of routine use of CS in the study population resulted in a cost savings of $182,552.28. Conclusion Utilizing cardiac surveillance in select women undergoing PLD treatment for gynecologic malignancies resulted in significant health care cost savings without adversely impacting clinical outcomes.

AB - Objective The study objective was to examine the safety and cost savings of selective cardiac surveillance (CS) during treatment with pegylated liposomal doxorubicin (PLD). Methods A retrospective, dual institution study of women receiving PLD for the treatment of a gynecologic malignancy was performed. The study period was 2002-2014. At both institutions, a selective strategy for CS was implemented in which only high-risk women with a cardiac history or with symptoms suggestive of cardiac toxicity during PLD treatment underwent a cardiac evaluation. Patient demographics, clinical and treatment history were evaluated. Cost analyses were performed utilizing professional/technical fee rates for echocardiogram and multi-gated acquisition scan for each state. Results PLD was administered in 184 women. The mean patient age was 62.7 years, and 79% were treated for recurrent ovarian or peritoneal carcinoma. The median cumulative administered dose of PLD was 300 mg/m2; 24 received > 550 mg/m2. The median follow-up time was 20 months. Of the 184 patients, the majority (n = 157, 85.3%) did not undergo either an initial cardiac evaluation or surveillance during or post-PLD treatment. Fifty-three patients considered high risk for anthracycline-induced cardiotoxicity underwent CS. Only three patients (1.6%) in the entire cohort developed CHF that was possibly related to PLD treatment; all had significant pre-existing cardiac risk factors. Selective instead of routine use of CS in the study population resulted in a cost savings of $182,552.28. Conclusion Utilizing cardiac surveillance in select women undergoing PLD treatment for gynecologic malignancies resulted in significant health care cost savings without adversely impacting clinical outcomes.

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KW - Echocardiogram

KW - Gynecologic malignancy

KW - Pegylated liposomal doxorubicin

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