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Chemotherapy-induced Cardiotoxicity and Mitigation · Journal article
Cancers · September 10, 2026
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This prospective cohort of 291 cancer patients receiving systemic therapy showed statistically significant increases in QTcF interval from baseline to 6 months (mean increase 8.7 ms), with only 6 subjects at baseline and an unspecified number at follow-up exceeding the 460 ms threshold. The authors conclude the absolute risk of QTc prolongation is relatively low, but the finding that the Bazett formula identifies substantially more cases than Fridericia (5.49-fold higher odds) raises questions about which correction method should guide clinical monitoring.
Prospective longitudinal cohort study. Cardiovascular disease-free subjects with cancer receiving systemic therapy, including 61.8% with breast cancer, 26.5% with hematologic malignancies, 7.3% with colorectal cancer, and 4.4% with kidney cancer.. Intervention: Systemic anticancer therapy (specific agents not detailed). n = 291. Not stated.
QTcF values differed significantly across timepoints (p = 0.0125) with significant increase from baseline 400.9 ± 29 ms to month 6 409.6 ± 25 ms (p = 0.0075) At baseline, 6 patients had QTcF ≥ 460 ms and 1 patient had QTcF ≥ 500 ms Bazett formula yielded 5.49 (95% CI 3.28–9.19) times higher odds of QTc ≥ 460 ms identification than Fridericia formula
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Clinicians should recognise that QTc prolongation during cancer therapy occurs but appears modest in absolute terms in this cohort. The strong dependence of QTc abnormality identification on the correction formula used (Fridericia vs. Bazett) suggests that standardisation of ECG monitoring protocols and threshold interpretation is critical for consistent risk stratification, though this finding alone does not establish a change in clinical practice.
A single-centre observational cohort study with surrogate ECG endpoints and modest sample size (n=291) examining QTc changes during cancer therapy; findings on QTc prolongation risk are descriptive and hypothesis-generating rather than practice-changing.
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Clinicians should recognise that QTc prolongation during cancer therapy occurs but appears modest in absolute terms in this cohort. The strong dependence of QTc abnormality identification on the correction formula used (Fridericia vs. Bazett) suggests that standardisation of ECG monitoring protocols and threshold interpretation is critical for consistent risk stratification, though this finding alone does not establish a change in clinical practice.
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Background/Objectives: Anticancer therapies are associated with a prolongation of QT interval of electrocardiogram (ECG), increasing the risk of arrhythmias. To evaluate this risk in cardiovascular disease-free subjects with cancer, ECG recorded at baseline, months 3, 6 and 12 from 291 participants from the ONCOECHO database were analyzed. Methods: Both Fridericia (QTcF), considered as standard, and Bazett (QTcB) formulas were used to calculate corrected QT (QTc). Results: The study cohort consisted of 61.8% subjects with breast cancer, 26.5% with hematologic malignancies, 7.3% with colorectal cancer and 4.4% of patients with kidney cancer. At baseline, six patients had a QTcF ≥ 460 ms and one ≥ 500 ms. QTcF values differed significantly across time points (p = 0.0125), with a significant increase between baseline and month 6 (400.9 ± 29 ms vs. 409.6 ± 25 ms, p = 0.0075). Use of the Bazett formula resulted in 5.49 (95% CI 3.28–9.19) higher odds of identification of QTc ≥ 460 ms than with the Fridericia rule. A LASSO logistic regression model identified age, QTcF at baseline and month 3 to increase odds of QTcF ≥ 460 ms, whereas higher ejection fraction was associated with decreased odds. Conclusions: Analysis shows that cancer patients receiving cardiotoxic therapy are at relatively low risk of QTc prolongation, but choosing the appropriate QTc correction formula is essential.
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