Utilization of cardiac tests in anthracycline-treated cancer survivors differs between young adults and children: A claims-based analysis

Background: The Children's Oncology Group Guidelines recommend a cardiacechocardiogram, or comparable functional imaging, following therapy completion in survivors of childhood/adolescent cancers exposed to anthracyclines.

Methods: Using the 2009-2019 Merative™ MarketScan® Commercial Database, we examined real-world utilization of cardiac testing among 1609 anthracycline-treated survivors of childhood/adolescent cancers.

Results: The cumulative incidence of receiving an initial cardiac test by 5.25 years from the index date (six months after end-of-therapy) was 62.3% (95% CI = 57.5%-66.7%), with median time to initial test being 2.7 years (95% CI = 2.5%-3.1%). Young adults (18-28 years) were less likely than children (≤17 years) to receive cardiac testing (hazard ratio [HR] = 0.42, 95% CI = 0.3%-0.49%). More likely to receive cardiac testing were survivors receiving hematopoietic stem cell transplantation versus chemotherapy only (HR = 2.23, 95% CI = 1.63%-3.03%), and survivors with bone or soft tissue versus hematologic cancer (HR = 1.64, 95% CI = 1.30%-2.07%).

Conclusions: Nearly 40% of anthracycline-treated survivors of childhood/adolescent cancers had not received cardiac testing within 5.25 years post-index date, with young adults least likely to receive a test.