Nationwide utilization of cardiac imaging in patients undergoing cardiotoxic chemotherapy.
Bibliographic record
Abstract
6592 Background: Current guidelines recommend cardiac evaluation in patients undergoing selected cardiotoxic regimens. However, utilization of cardiac imaging and adherence to guidelines have not been previously examined in a nationally representative cancer patient population. Methods: Retrospective SEER-Medicare analysis of patients with incident cancer of the breast, lung, colon, prostate (metastatic), leukemia (acute) or lymphoma between 2000 and 2009. We examined claims-based receipt of chemotherapy, cardiotoxic chemotherapy (anthracycline, trastuzumab, or bevacizumab) and their association with cardiac evaluation in the year following diagnosis. Results: A total of 346,903 patients met study criteria (Table). Receipt of cardiotoxic chemotherapy ranged from 1% in prostate cancer to 35% in lymphoma. Overall, 43% of patients underwent cardiac evaluation (84% echo, 30% exercise EKG, 9% MUGA, 1% nuclear imaging, 0.2% cardiac PET). Among patients receiving cardiotoxic chemotherapy, 80-90% of breast, leukemia, and lymphoma patients underwent one or more cardiac studies compared to only 40-60% of patients with colorectal, lung, or prostate cancer. Conclusions: Cardiac evaluation appears more common in cancer populations more frequently treated with cardiotoxic chemotherapy than in cancer populations with less exposure to these agents. Increased awareness of cardio-oncologic principles may be warranted among oncologists treating cancer types for which cardiotoxicity has not historically been a concern. Cardiac imaging utilization by receipt of systemic and cardiotoxic therapy, 2000-2009. Cohort Total Patients (N = 346,903) Systemic Chemotherapy Cardiac Imaging Any† Cardiotoxic Chemotherapy No Chemotherapy Any Noncardiotoxic Chemotherapy Cardiotoxic Chemotherapy Acute Leukemia 9,621 13% 2% 51% 73% 85% Breast Curative 86,261 20% 12% 27% 68% 84% Palliative 6,882 37% 23% 36% 72% 83% Colorectal Curative 84,504 25% 2% 46% 41% 48% Palliative 20,277 41% 14% 37% 39% 42% Lung Curative 29,715 25% 1% 57% 61% 62% Palliative 78,509 40% 3% 34% 43% 48% Lymphoma Early Stage 10,902 56% 36% 41% 76% 89% Late Stage 12,835 64% 35% 51% 75% 91% Metastatic Prostate 7,397 8% 1% 33% 38% 61%
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".