title: Cardiac monitoring during adjuvant trastuzumab therapy: Guideline adherence in clinical practice.
abstract: BACKGROUND
  Cardiotoxicity is an important adverse effect of adjuvant breast cancer treatment with trastuzumab and three monthly left ventricular ejection fraction (LVEF) monitoring is considered mandatory. The purpose of this study was to gain insight into LVEF monitoring during adjuvant trastuzumab treatment in clinical practice.
  
  
  METHODS
  In a multicenter retrospective study encompassing 328 patients, of which 171 patients were actually treated with trastuzumab, we analyzed the frequency and mode of LVEF monitoring and compared it with LVEF monitoring guidelines.
  
  
  RESULTS
  The results indicated poor guideline adherence. In 9% of patients trastuzumab was started in spite of a low LVEF (< 55%). In 24% of patients no valid baseline LVEF value was available. LVEF measurements during treatment at three, six and 12 months were only performed in, respectively, 53%, 40% and 30% of patients.
  
  
  CONCLUSIONS
  A significant proportion of patients are treated with trastuzumab, while LVEF monitoring is not adequately performed. More attention should be paid to the implementation of (cardiac assessment) guidelines in clinical practice.
authors.affiliation: a Department of Medical Psychology , Radboud university medical center , Nijmegen , The Netherlands.
authors.forename: Annemiek
authors.initials: A
authors.lastname: Visser
authors.affiliation: b Department of Medical Oncology , Radboud university medical center , Nijmegen , The Netherlands.
authors.forename: Eline M W
authors.initials: EM
authors.lastname: van de Ven
authors.affiliation: b Department of Medical Oncology , Radboud university medical center , Nijmegen , The Netherlands.
authors.forename: Larissa I A
authors.initials: LI
authors.lastname: Ruczynski
authors.affiliation: c Department of Medical Oncology , Rijnstate, Arnhem , The Netherlands.
authors.forename: Reinoud J B
authors.initials: RJ
authors.lastname: Blaisse
authors.affiliation: d Department of Medical Oncology , Gelderse Vallei, Ede , The Netherlands.
authors.forename: Henk K
authors.initials: HK
authors.lastname: van Halteren
authors.affiliation: e Comprehensive Cancer Centre The Netherlands , Utrecht , The Netherlands.|f Department for Health Evidence , Radboud university medical center , Nijmegen , The Netherlands.
authors.forename: Katja
authors.initials: K
authors.lastname: Aben
authors.affiliation: b Department of Medical Oncology , Radboud university medical center , Nijmegen , The Netherlands.|g Department of Medical Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.
authors.forename: Hanneke W M
authors.initials: HW
authors.lastname: van Laarhoven
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D000068878:Trastuzumab / Q000009:adverse effects* / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
chemical_list: D000970:Antineoplastic Agents; D000068878:Trastuzumab