Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
Nurses - 0.25 ANCC Contact Hour(s) (0.25 contact hours are in the area of pharmacology)
Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)
Physician Assistant - 0.25 AAPA hour(s) of Category I credit
IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit
This activity is intended for primary care physicians, oncologists, cardiologists, nurses, pharmacists, physician assistants, and other members of the healthcare team who care for patients with cancer.
The goal of this activity is for learners to be better able to analyze the risk for atrial fibrillation (AF) associated with anticancer drugs.
Upon completion of this activity, participants will:
Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.
This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.
Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.
The European Union of Medical Specialists (UEMS)-European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).
College of Family Physicians of Canada Mainpro+® participants may claim certified credits for any AMA PRA Category 1 credit(s)™, up to a maximum of 50 credits per five-year cycle. Any additional credits are eligible as non-certified credits. College of Family Physicians of Canada (CFPC) members must log into Mainpro+® to claim this activity.
Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.
Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.25 contact hours are in the area of pharmacology.
Medscape designates this continuing education activity for 0.25 contact hour(s) (0.025 CEUs) (Universal Activity Number: JA0007105-0000-23-155-H01-P).
Medscape, LLC has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid until 5/5/2024. PAs should only claim credit commensurate with the extent of their participation.
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability
and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
activity online during the valid credit period that is noted on the title page. To receive
AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.
Follow these steps to earn CME/CE credit*:
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it.
Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print
out the tally as well as the certificates from the CME/CE Tracker.
*The credit that you receive is based on your user profile.
CME / ABIM MOC / CE Released: 5/5/2023
Valid for credit through: 5/5/2024
processing....
Patients with cancer are at risk for a large number of potential adverse events (AEs) during treatment and even years thereafter, and the current study highlights the risk for atrial fibrillation (AF) among patients with a history of cancer. Atrial fibrillation accounts for nearly 5% of cardiovascular (CV) AEs in clinical trials of cancer treatment, and previous research has found that the diagnosis of cancer is associated with a 47% increase in the risk for incident AF. Another study of women with breast cancer found that the diagnosis of AF within 30 days of the diagnosis of cancer was associated with more than a 2-fold increase in the risk for death at 1 year.
Many factors can increase the risk for AF among patients with cancer, including higher levels of inflammation, immune dysregulation, and electrolyte abnormalities. Higher stages of cancer are also associated with higher risks for AF, but the application of anticancer drugs might also contribute to AF among patients with cancer, and the current study by Alexandre and colleagues uses clinical trial data to assess the significance of this potential association.
Atrial fibrillation is a known and serious AE of some cancer treatments, but it is underreported in cancer drug trials, French investigators said in a new report.
As a result, oncologists likely underestimate the risk for AF when new cancer drugs come to market, they said.
The team came to these conclusions after conducting a meta-analysis of 191 phase 2 or 3 clinical trials that included 26,604 patients. The trials investigated 15 anticancer drugs used as monotherapy.
The meta-analysis showed that the annualized incidence rate of AF ranged from 0.26 cases per 100 person-years (PY): about the same as placebo to 4.92 cases, a nearly 20 times' higher risk.
Rates were the highest for ibrutinib, clofarabine, and ponatinib.
The study was published on March 28 in JACC: Cardio-Oncology, a journal of the American College of Cardiology.[1]
Actual rates of AF are probably higher than what they found in this meta-analysis, the authors suspected, because most oncology trials only identify and report severe cases of AF that require immediate medical attention. Less severe cases can also lead to serious complications, including strokes, but they go unreported, said investigators led by Joachim Alexandre, MD, PhD, a member of the cardio-oncology program at the University of Caen Normandie Hospital Center, Caen, France.
"These findings suggest a global and systemic underreporting and/or under-identification of cardiotoxicity among cancer clinical trial participants," and AF reporting is "particularly affected," they said.
Call for Routine MonitoringThe root of the problem is the lack of routine rhythm monitoring in cancer trials. This, in turn, "leads to a significant underestimation of AF incidence" and rates "markedly lower than those observed among real-life" patients, the authors pointed out.
To address the issue, Alexandre and his team called for routine cardiac monitoring in trials to capture the true incidence of AF and to "clearly define which anticancer drugs are significantly associated" with the condition.
Approached for comment, Michael Fradley, MD, medical director of cardio-oncology at the University of Pennsylvania, Philadelphia, Pennsylvania, agreed.
"It's incredibly important" to "identify the drugs most likely to cause arrhythmias and determine the best prevention and treatment strategies. Unfortunately, systematic evaluation of arrhythmias in cancer clinical trials has often been lacking," Fradley told Medscape Medical News.
The investigators said the issue is particularly pressing for drugs known to be associated with AF. For Bruton tyrosine kinase inhibitors, they called for standardize AF detection in trials "not only on 12-lead ECGs" for symptomatic AF but also with "longer-term ambulatory monitoring or insertable cardiac monitors to detect subclinical AF."
Fradley thought there might also be a role for newer wearable technologies that can detect arrhythmias through a skin patch or by other means.
Details of the Meta-AnalysisThe investigators pulled the 191 studies they used in their meta-analysis from the ClinicalTrials.gov database.
The trials covered anticancer drugs used as monotherapy up to September 18, 2020. Almost half were randomized trials, but only 7 had placebo arms. Trials involving hematologic cancers outnumbered those involving solid tumors.
The 15 drugs examined were dacarbazine, abiraterone, clofarabine, azacitidine, ibrutinib, nilotinib, ponatinib, midostaurin, ipilimumab, aldesleukin, lenalidomide, pomalidomide, rituximab, bortezomib, and docetaxel.
The annualized incidence AF rates per 100 PY were 4.92 cases for ibrutinib, 2.38 cases for clofarabine, and 2.35 cases for ponatinib.
The lowest AF rates were for ipilimumab (0.26 cases), rituximab (0.27), and nilotinib (0.29).
For placebo, the annualized rate was 0.25 cases per 100 PY.
The team says caution is warranted regarding their estimations for clofarabine and midostaurin (0.65 cases) because no trials were registered after September 2009, when AE reporting became mandatory. As a result, estimates may be artificially low.
One of the limits of the study is that it focused on monotherapy in an age when combination treatment is generally the rule for cancer, the authors noted.
No external funding was reported for the study. Alexandre has received honoraria for presentations and consulting fees from Amgen Inc.; Bayer AG; Bioserenity; Bristol-Myers Squibb Company; and Pfizer Inc.