Reported Signs, Symptoms, and Diagnostic Tests Before Cardiotoxicity Among Women With Breast Cancer: A Pilot Study.
Mina Attin, Karen Reifenstein, Sakshi Mehta and 3 others
PMID 34369915WHAT IT FOUND
Before cardiotoxicity was diagnosed in women with breast cancer, records showed large changes in lower leg swelling, chest pain, breathing difficulty and neuropathy.
This small pilot cannot show these signs predict cardiotoxicity.
Key findings
01In the six months before cardiotoxicity, reported signs and symptoms changed between the first and second halves: lower extremity edema 588%, chest pain 140%, difficulty in breathing 113%, fatigue 5.3%, and neuropathy 212%.
02Eleven patients had new onset of one or a combination of signs and symptoms within three months before cardiotoxicity; before diagnosis, lower extremity edema was reported 41 ± 29 days, chest pain 39 ± 25 days, difficulty in breathing 31 ± 17 days, and neuropathy 29 ± 11 days.
03Between the first and second halves of the six months before cardiotoxicity, albumin was 4.21 ± .41 then 3.91 ± .39 g/dL, total protein was 6.81 ± .82 then 6.45 ± .59 g/dL, and alanine aminotransferase was 30.67 ± 26.27 then 42.31 ± 35.65 U/L; B-type natriuretic peptide was not recorded and only two patients had troponin I.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a pilot retrospective chart review, not a test of whether signs or symptoms predict cardiotoxicity. There was no comparison group of women with breast cancer who did not develop cardiotoxicity. The paper does not state the total number of patients, so the size of the sample cannot be checked directly. Signs and symptoms were not verified with patients; they were taken from electronic health records. Key biomarkers were missing or sparse: B-type natriuretic peptide was not recorded, and troponin was available for only two patients. ECG data were incomplete, and QTc could not be measured for many patients because of artifacts or conduction abnormalities. Chemotherapy doses and radiation details were not available. Some patients had cardiovascular disease, and the study cannot separate symptoms caused by cancer treatment from symptoms caused by cardiotoxicity.
Declared interests
The authors declare no conflict of interest. The publication types note NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not read the large percentage changes as evidence that lower leg swelling or neuropathy predict cardiotoxicity. This was a retrospective pilot with no control group, incomplete biomarker data, and the paper does not state the total number of patients.