Anthracycline-related cardiotoxicity is a well-established, potentially life-altering consequence of cancer treatment — one that can silently erode cardiac function years after the last chemotherapy dose. For adolescents and young adults, who may survive decades past their cancer diagnosis, the stakes of inadequate cardiac surveillance are particularly high. Understanding how consistently real-world clinical practice actually follows monitoring guidance is therefore a critical quality-of-care question.
This descriptive study examined echocardiographic monitoring patterns in 1,459 adolescent and young adult (AYA) cancer patients aged 15–39 (mean age 31.7 years; 65.1% female) who initiated anthracycline chemotherapy in Japan between April 2012 and July 2020, using a national health insurance claims database. While 60.4% received a baseline echocardiogram within 180 days before treatment, monitoring dropped sharply during active therapy — only 13.7% had any echocardiography during treatment cycles, and pre-cycle monitoring ranged from 8.2% before cycle two to 20.9% before cycle six. Post-treatment surveillance within one year reached 41.0%. Younger patients (ages 15–29), males, those with lymphoma or leukemia, patients with pre-existing heart failure, and those treated at designated cancer centers were more likely to receive baseline imaging. Breast cancer patients and those treated at non-university clinics were notably less likely.
These findings underscore a persistent implementation gap between cardio-oncology guidelines and frontline practice. The irony is striking: breast cancer patients — a group with among the highest cumulative anthracycline exposure and longest survivorship — were less likely to receive baseline echos. This may reflect historical assumptions about lower-intensity regimens or competing clinical priorities, but it conflicts with contemporary guidance from bodies like the European Society of Cardiology and the American Society of Echocardiography. The study's administrative claims design limits clinical granularity — cumulative dosage, ejection fraction trends, and symptom data are absent — and single-country findings may not generalize globally. Nonetheless, this is a valuable real-world audit that positions cardiac surveillance optimization as an urgent, actionable gap in AYA oncology care.