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Arrhythmias and sudden death
Original research article
Underuse of ECG monitoring in oncology patients receiving QT-interval prolonging drugs
  1. Rossanna C Pezo1,
  2. Andrew T Yan2,
  3. Craig Earle1,
  4. Kelvin K Chan1,3
  1. 1 Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2 Division of Cardiology, St. Michael’s Hospital, Toronto, Ontario, Canada
  3. 3 Canadian Centre for Applied Research in Cancer Control, Canada
  1. Correspondence to Dr Rossanna C Pezo, Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto ON M4N 3M5, Canada; rossanna.pezo{at}sunnybrook.ca

Abstract

Objective We examined use of ECG monitoring in oncology patients prescribed QT-prolonging drugs.

Methods Patients ≥66 years diagnosed with cancer between 2005 and 2011 were identified through the Ontario Cancer Registry and linked to multiple population-based administrative databases to ascertain demographics, comorbidities, prescription drug use, systemic therapy and ECG. QT-prolonging drugs were identified as per drug lists developed by the Arizona Center for Education and Research on Therapeutics. Univariable and multivariable analyses were used to examine factors associated with ECG use in patients on first-line systemic therapy.

Results A total of 48 236 patients (median age 74; 49% women) received one or more drugs associated with a risk of QT-interval prolongation but only 27% of patients had an ECG performed. Factors associated with more ECG use on multivariable analysis included recent cancer diagnosis (p for trend <0.001 between 2005 and 2011), use of concurrent QT-prolonging drugs (OR=1.15 per each additional QT-prolonging drug, 95% CI 1.12 to 1.17) and the presence of coronary artery disease (OR 1.31; 95% CI 1.25 to 1.38) and heart failure (OR 1.25; 95% CI 1.17 to 1.35). Use of anticancer (OR 0.74; 95% CI 0.70 to 0.79) and antiemetic (OR 0.93; 95% CI 0.88 to 0.99) QT-prolonging drugs was paradoxically associated with less ECG use.

Conclusions Our study highlights common use of QT-prolonging drugs and underuse of ECG in oncology patients. Since ECG is an inexpensive, non-invasive and widely available test, it may be readily incorporated in the monitoring of patients for toxicities in routine clinical practice.

  • ECG/electrocardiogram
  • quality and outcomes of care
  • health care delivery
  • drug monitoring

https://doi.org/10.1136/heartjnl-2018-314674

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    Footnotes

    • Contributors All authors were involved in the design of this research study and in the analysis and interpretation of the data. The manuscript was written by RCP with input from all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Presented at Part of this work was presented in abstract form at the 2018 American Society for Clinical Oncology Annual Meeting in Chicago, Illinois, USA.

    • Patient consent for publication Not required.