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Sadler D, Okwuosa T, Teske AJ, Guha A, Collier P, Moudgil R, Sarkar A, Brown SA. Cardio oncology: Digital innovations, precision medicine and health equity. Front Cardiovasc Med 2022; 9:951551. [PMID: 36407451 PMCID: PMC9669068 DOI: 10.3389/fcvm.2022.951551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
The rapid emergence of cardio-oncology has resulted in a rapid growth of cardio-oncology programs, dedicated professional societies sections and committees, and multiple collaborative networks that emerged to amplify the access to care in this new subspecialty. However, most existing data, position statements and guidelines are limited by the lack of availability of large clinical trials to support these recommendations. Furthermore, there are significant challenges regarding proper access to cardio-oncology care and treatment, particularly in marginalized and minority populations. The emergence and evolution of personalized medicine, artificial intelligence (AI), and machine learning in medicine and in cardio-oncology provides an opportunity for a more targeted, personalized approach to cardiovascular complications of cancer treatment. The proper implementation of these new modalities may facilitate a more equitable approach to adequate and universal access to cardio-oncology care, improve health related outcomes, and enable health care systems to eliminate the digital divide. This article reviews and analyzes the current status on these important issues.
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Stabellini N, Cullen J, Moore JX, Cao L, Agarwal N, Hamerschlak N, Waite K, Montero AJ, Barnholtz-Sloan JS, Guha A. Racial Differences in Chronic Stress/Allostatic Load Variation Due to Androgen Deprivation Therapy in Prostate Cancer. JACC CardioOncol 2022; 4:555-557. [PMID: 36909936 PMCID: PMC9998463 DOI: 10.1016/j.jaccao.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Guha A, Gong Y, DeRemer D, Owusu-Guha J, Dent SF, Cheng RK, Weintraub NL, Agarwal N, Fradley MG. Cardiometabolic Consequences of Targeted Anticancer Therapies. J Cardiovasc Pharmacol 2022; 80:515-521. [PMID: 34654781 PMCID: PMC8977391 DOI: 10.1097/fjc.0000000000001149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/25/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cardiometabolic disease (CMD) is the most common preventable cause of death in the world. A number of components are included in the spectrum of CMD, such as metabolic syndrome/obesity, hyperglycemia/diabetes, dyslipidemia, and hypertension, which are independently associated with cardiovascular disease risk. These conditions often occur together, and patients with cancer frequently undergo treatments that can generate or worsen CMD. This review highlights and presents mechanistic and epidemiological evidence regarding CMD in 4 categories of anticancer medications, namely, mTOR/PI3K-Akt inhibitors, multitargeted tyrosine kinase inhibitor, immune checkpoint inhibitor therapy, and endocrine therapy. Patients taking these medications need careful monitoring during therapy. There is a role for cardio-oncology and onco-primary care specialists in optimally managing patients at risk to mitigate CMD during treatment with these and other investigational anticancer medications.
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Dent SF, Moore H, Raval P, Alder L, Guha A. How to Manage and Monitor Cardiac Dysfunction in Patients With Metastatic HER2-Positive Breast Cancer. JACC CardioOncol 2022; 4:404-408. [PMID: 36213363 PMCID: PMC9537063 DOI: 10.1016/j.jaccao.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022] Open
Abstract
Targeted therapies improve clinical outcomes in HER2+ metastatic breast cancer. There is thus far minimal signal of increased risk of cardiotoxicity from novel HER2 targeted therapies. Cancer therapy benefit drives clinical decision-making with LV dysfunction. The frequency of cardiac monitoring should be based on a risk-benefit approach.
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Coughlin SS, Datta B, Guha A, Wang X, Weintraub NL. Cardiovascular Health Among Cancer Survivors. From the 2019 Behavioral Risk Factor Surveillance System Survey. Am J Cardiol 2022; 178:142-148. [PMID: 35773041 PMCID: PMC10462909 DOI: 10.1016/j.amjcard.2022.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Abstract
With increasing prevalence, there is a growing population living with cardiovascular (CV) disease and cancer who are concurrently or at risk for developing these 2 disease states. We examined CV conditions and CV risk factors in cancer survivors in a cross-sectional analysis, using data from the 2019 Behavioral Risk Factor Surveillance System. Cancer survivors are more likely than participants without a cancer history to have multiple risk factors that increase their risk for CV disease and other chronic illnesses, including cigarette smoking, physical inactivity, and obesity. In contrast, cancer survivors are less likely to be heavy drinkers or to not consume fruits and vegetables. The odds of having a heart attack, coronary heart disease (CHD), diabetes, and hypertension were generally higher among cancer survivors. In multivariable analysis, the adjusted odds of having a heart attack, CHD, diabetes, hypertension, or high cholesterol were higher among cancer survivors than among participants without a history of cancer. Although the odds of obesity and physical inactivity were generally higher among cancer survivors across all socioeconomic status groups, the odds of having a heart attack or CHD were particularly high among Black and Hispanic cancer survivors and among younger participants. The odds of having diabetes were also higher among Black and Hispanic cancer survivors. In conclusion, cancer survivors are more likely than participants without a cancer history to have multiple risk factors that increase their risk of CV disease and other chronic illnesses, and they have a higher prevalence of heart attack, CHD, diabetes, and hypertension. Of particular concern are the higher prevalence of heart attack, CHD, and diabetes among Black and Hispanic cancer survivors.
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Ganatra S, Dani SS, Kumar A, Khan SU, Wadhera R, Neilan TG, Thavendiranathan P, Barac A, Hermann J, Leja M, Deswal A, Fradley M, Liu JE, Sadler D, Asnani A, Baldassarre LA, Gupta D, Yang E, Guha A, Brown SA, Stevens J, Hayek SS, Porter C, Kalra A, Baron SJ, Ky B, Virani SS, Kazi D, Nasir K, Nohria A. Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States. JACC CardioOncol 2022; 4:326-337. [PMID: 36213357 PMCID: PMC9537091 DOI: 10.1016/j.jaccao.2022.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Racial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD). Objectives The aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD. Methods The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC's Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD. Results The AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences. Conclusions Comorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology.
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Guha A, Stabellini N, Montero AJ. Commentary: Longitudinal changes in circulating metabolites and lipoproteins after breast cancer treatment. Front Cardiovasc Med 2022; 9:962698. [PMID: 36017091 PMCID: PMC9395698 DOI: 10.3389/fcvm.2022.962698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
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Maddula R, MacLeod J, Painter S, McLeish T, Steward A, Rossman A, Hamid A, Ashwath M, Martinez HR, Guha A, Patel B, Addison D, Blaes A, Choudhuri I, Brown SA. Connected Health Innovation Research Program (C.H.I.R.P.): A bridge for digital health and wellness in cardiology and oncology. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 20:100192. [PMID: 37800118 PMCID: PMC10552440 DOI: 10.1016/j.ahjo.2022.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Study objective Cancer and heart disease are leading causes of mortality, and cardio-oncology is emerging as a new field addressing the cardiovascular toxicities related to cancer and cancer therapy. Interdisciplinary research platforms that incorporate digital health to optimize cardiovascular health and wellness in cancer survivors are therefore needed as we advance in the digital era. Our goal was to develop the Connected Health Innovation Research Program (C.H.I.R.P.) to serve as a foundation for future integration and assessments of adoption and clinical efficacy of digital health tools for cardiovascular health and wellness in the general population and in oncology patients. Design/setting/participants Partner companies were identified through the American Medical Association innovation platform, as well as LinkedIn and direct contact by our team. Company leaders met with our team to discuss features of their technology or software. Non-disclosure agreements were signed and data were discussed and obtained for descriptive or statistical analysis. Results A suite of companies with technologies focused on wellness, biometrics tracking, audio companions, oxygen saturation, weight trends, sleep patterns, heart rate variability, electrocardiogram patterns, blood pressure patterns, real-time metabolism tracking, instructional video modules, or integration of these technologies into electronic health records was collated. We formed an interdisciplinary research team and established an academia-industry collaborative foundation for connecting patients with wellness digital health technologies. Conclusions A suite of software and device technologies accessible to the cardiology and oncology population has been established and will facilitate retrospective, prospective, and case research studies assessing adoption and clinical efficacy of digital health tools in cardiology/oncology.
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Sharma R, Abbasi-Kangevari M, Abd-Rabu R, Abidi H, Abu-Gharbieh E, Acuna JM, Adhikari S, Advani SM, Afzal MS, Aghaie Meybodi M, Ahinkorah BO, Ahmad S, Ahmadi A, Ahmadi S, Ahmed H, Ahmed LA, Ahmed MB, Al Hamad H, Alahdab F, Alanezi FM, Alanzi TM, Alhalaiqa FAN, Alimohamadi Y, Alipour V, Aljunid SM, Alkhayyat M, Almustanyir S, Al-Raddadi RM, Alvand S, Alvis-Guzman N, Amini S, Ancuceanu R, Anoushiravani A, Anoushirvani AA, Ansari-Moghaddam A, Arabloo J, Aryannejad A, Asghari Jafarabadi M, Athari SS, Ausloos F, Ausloos M, Awedew AF, Awoke MA, Ayana TM, Azadnajafabad S, Azami H, Azangou-Khyavy M, Azari Jafari A, Badiye AD, Bagherieh S, Bahadory S, Baig AA, Baker JL, Banach M, Barrow A, Berhie AY, Besharat S, Bhagat DS, Bhagavathula AS, Bhala N, Bhattacharyya K, Bhojaraja VS, Bibi S, Bijani A, Biondi A, Bjørge T, Bodicha BBA, Braithwaite D, Brenner H, Calina D, Cao C, Cao Y, Carreras G, Carvalho F, Cerin E, Chakinala RC, Cho WCS, Chu DT, Conde J, Costa VM, Cruz-Martins N, Dadras O, Dai X, Dandona L, Dandona R, Danielewicz A, Demeke FM, Demissie GD, Desai R, Dhamnetiya D, Dianatinasab M, Diaz D, Didehdar M, Doaei S, Doan LP, Dodangeh M, Eghbalian F, Ejeta DD, Ekholuenetale M, Ekundayo TC, El Sayed I, Elhadi M, Enyew DB, Eyayu T, Ezzeddini R, Fakhradiyev IR, Farooque U, Farrokhpour H, Farzadfar F, Fatehizadeh A, Fattahi H, Fattahi N, Fereidoonnezhad M, Fernandes E, Fetensa G, Filip I, Fischer F, Foroutan M, Gaal PA, Gad MM, Gallus S, Garg T, Getachew T, Ghamari SH, Ghashghaee A, Ghith N, Gholamalizadeh M, Gholizadeh Navashenaq J, Gizaw AT, Glasbey JC, Golechha M, Goleij P, Gonfa KB, Gorini G, Guha A, Gupta S, Gupta VB, Gupta VK, Haddadi R, Hafezi-Nejad N, Haj-Mirzaian A, Halwani R, Haque S, Hariri S, Hasaballah AI, Hassanipour S, Hay SI, Herteliu C, Holla R, Hosseini MS, Hosseinzadeh M, Hostiuc M, Househ M, Huang J, Humayun A, Iavicoli I, Ilesanmi OS, Ilic IM, Ilic MD, Islami F, Iwagami M, Jahani MA, Jakovljevic M, Javaheri T, Jayawardena R, Jebai R, Jha RP, Joo T, Joseph N, Joukar F, Jozwiak JJ, Kabir A, Kalhor R, Kamath A, Kapoor N, Karaye IM, Karimi A, Kauppila JH, Kazemi A, Keykhaei M, Khader YS, Khajuria H, Khalilov R, Khanali J, Khayamzadeh M, Khodadost M, Kim H, Kim MS, Kisa A, Kisa S, Kolahi AA, Koohestani HR, Kopec JA, Koteeswaran R, Koyanagi A, Krishnamoorthy Y, Kumar GA, Kumar M, Kumar V, La Vecchia C, Lami FH, Landires I, Ledda C, Lee SW, Lee WC, Lee YY, Leong E, Li B, Lim SS, Lobo SW, Loureiro JA, Lunevicius R, Madadizadeh F, Mahmoodpoor A, Majeed A, Malekpour MR, Malekzadeh R, Malik AA, Mansour-Ghanaei F, Mantovani LG, Martorell M, Masoudi S, Mathur P, Meena JK, Mehrabi Nasab E, Mendoza W, Mentis AFA, Mestrovic T, Miao Jonasson J, Miazgowski B, Miazgowski T, Mijena GFW, Mirmoeeni S, Mirza-Aghazadeh-Attari M, Mirzaei H, Misra S, Mohammad KA, Mohammadi E, Mohammadi S, Mohammadi SM, Mohammadian-Hafshejani A, Mohammed S, Mohammed TA, Moka N, Mokdad AH, Mokhtari Z, Molokhia M, Momtazmanesh S, Monasta L, Moradi G, Moradzadeh R, Moraga P, Morgado-da-Costa J, Mubarik S, Mulita F, Naghavi M, Naimzada MD, Nam HS, Natto ZS, Nayak BP, Nazari J, Nazemalhosseini-Mojarad E, Negoi I, Nguyen CT, Nguyen SH, Noor NM, Noori M, Noori SMA, Nuñez-Samudio V, Nzoputam CI, Oancea B, Odukoya OO, Oguntade AS, Okati-Aliabad H, Olagunju AT, Olagunju TO, Ong S, Ostroff SM, Padron-Monedero A, Pakzad R, Pana A, Pandey A, Pashazadeh Kan F, Patel UK, Paudel U, Pereira RB, Perumalsamy N, Pestell RG, Piracha ZZ, Pollok RCG, Pourshams A, Pourtaheri N, Prashant A, Rabiee M, Rabiee N, Radfar A, Rafiei S, Rahman M, Rahmani AM, Rahmanian V, Rajai N, Rajesh A, Ramezani-Doroh V, Ramezanzadeh K, Ranabhat K, Rashedi S, Rashidi A, Rashidi M, Rashidi MM, Rastegar M, Rawaf DL, Rawaf S, Rawassizadeh R, Razeghinia MS, Renzaho AMN, Rezaei N, Rezaei N, Rezaei S, Rezaeian M, Rezazadeh-Khadem S, Roshandel G, Saber-Ayad MM, Saberzadeh-Ardestani B, Saddik B, Sadeghi H, Saeed U, Sahebazzamani M, Sahebkar A, Salek Farrokhi A, Salimi A, Salimzadeh H, Samadi P, Samaei M, Samy AM, Sanabria J, Santric-Milicevic MM, Saqib MAN, Sarveazad A, Sathian B, Satpathy M, Schneider IJC, Šekerija M, Sepanlou SG, Seylani A, Sha F, Shafiee SM, Shaghaghi Z, Shahabi S, Shaker E, Sharifian M, Sharifi-Rad J, Sheikhbahaei S, Shetty JK, Shirkoohi R, Shobeiri P, Siddappa Malleshappa SK, Silva DAS, Silva Julian G, Singh AD, Singh JA, Siraj MS, Sivandzadeh GR, Skryabin VY, Skryabina AA, Socea B, Solmi M, Soltani-Zangbar MS, Song S, Szerencsés V, Szócska M, Tabarés-Seisdedos R, Tabibian E, Taheri M, TaheriAbkenar Y, Taherkhani A, Talaat IM, Tan KK, Tbakhi A, Tesfaye B, Tiyuri A, Tollosa DN, Touvier M, Tran BX, Tusa BS, Ullah I, Ullah S, Vacante M, Valadan Tahbaz S, Veroux M, Vo B, Vos T, Wang C, Westerman R, Woldemariam M, Yahyazadeh Jabbari SH, Yang L, Yazdanpanah F, Yu C, Yuce D, Yunusa I, Zadnik V, Zahir M, Zare I, Zhang ZJ, Zoladl M. Global, regional, and national burden of colorectal cancer and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Gastroenterol Hepatol 2022; 7:627-647. [PMID: 35397795 PMCID: PMC9192760 DOI: 10.1016/s2468-1253(22)00044-9] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Colorectal cancer is the third leading cause of cancer deaths worldwide. Given the recent increasing trends in colorectal cancer incidence globally, up-to-date information on the colorectal cancer burden could guide screening, early detection, and treatment strategies, and help effectively allocate resources. We examined the temporal patterns of the global, regional, and national burden of colorectal cancer and its risk factors in 204 countries and territories across the past three decades. METHODS Estimates of incidence, mortality, and disability-adjusted life years (DALYs) for colorectal cancer were generated as a part of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 by age, sex, and geographical location for the period 1990-2019. Mortality estimates were produced using the cause of death ensemble model. We also calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer. FINDINGS Globally, between 1990 and 2019, colorectal cancer incident cases more than doubled, from 842 098 (95% uncertainty interval [UI] 810 408-868 574) to 2·17 million (2·00-2·34), and deaths increased from 518 126 (493 682-537 877) to 1·09 million (1·02-1·15). The global age-standardised incidence rate increased from 22·2 (95% UI 21·3-23·0) per 100 000 to 26·7 (24·6-28·9) per 100 000, whereas the age-standardised mortality rate decreased from 14·3 (13·5-14·9) per 100 000 to 13·7 (12·6-14·5) per 100 000 and the age-standardised DALY rate decreased from 308·5 (294·7-320·7) per 100 000 to 295·5 (275·2-313·0) per 100 000 from 1990 through 2019. Taiwan (province of China; 62·0 [48·9-80·0] per 100 000), Monaco (60·7 [48·5-73·6] per 100 000), and Andorra (56·6 [42·8-71·9] per 100 000) had the highest age-standardised incidence rates, while Greenland (31·4 [26·0-37·1] per 100 000), Brunei (30·3 [26·6-34·1] per 100 000), and Hungary (28·6 [23·6-34·0] per 100 000) had the highest age-standardised mortality rates. From 1990 through 2019, a substantial rise in incidence rates was observed in younger adults (age <50 years), particularly in high Socio-demographic Index (SDI) countries. Globally, a diet low in milk (15·6%), smoking (13·3%), a diet low in calcium (12·9%), and alcohol use (9·9%) were the main contributors to colorectal cancer DALYs in 2019. INTERPRETATION The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions. FUNDING Bill & Melinda Gates Foundation.
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Guha A, Jain A, Aggarwal A, Dey AK, Dani S, Ganatra S, Marchlinski FE, Addison D, Fradley MG. Length of stay and cost of care associated with admissions for atrial fibrillation among patients with cancer. BMC Cardiovasc Disord 2022; 22:272. [PMID: 35715747 PMCID: PMC9205123 DOI: 10.1186/s12872-022-02697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/01/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The aim of this study is to assess the burden of AF-related hospitalizations inclusive of inflation-adjusted cost-of-care and length-of-stay (LOS) among cancer patients and the impact of direct current cardioversion (DCCV) on these outcomes. METHODS Using the National Inpatient Sample (NIS), patients hospitalized with either a primary or secondary diagnosis of AF and comorbid cancer were identified and both cost of hospitalization and LOS were evaluated for each group. Subgroup analyses were performed for specific cancer types (breast, lung, colon, prostate and lymphoma), and those receiving DCCV. RESULTS The prevalence of co-morbid AF was 8.2 million (16%) and 35.5 million (10%) among those with vs. those without cancer, respectively (odds ratio = 1.6, 95% confidence interval = 1.5-1.7; P < 0.001). Over time, both primary and prevalent AF admissions among those with comorbid cancer increased from 1.1% and 12.3% in 2003 to 1.5% and 21% in 2015, respectively. The total cost of hospitalization increased 94.4% among those with AF and comorbid cancer compared to 23.9% among those without cancer. Among the subgroup of patients with comorbid cancer and primary admission for AF undergoing DCCV, length of stay (2.7 vs. 2.2 days; P < 0.001, model 1) and cost of care ($7,093 vs. 6,152; P < 0.001) were both significantly higher. CONCLUSIONS AF related admissions are increasing for all populations especially amongst those patients with a comorbid diagnosis of cancer, including all cancer subtypes evaluated. Among those patients who underwent DCCV, cancer patients had longer length of stay and increased health care costs.
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Guha A, Sayegh N, Agarwal N. Targeting Cardiovascular Adverse Events of Metastatic Renal Cell Carcinoma Therapies. JACC CardioOncol 2022; 4:235-237. [PMID: 35818554 PMCID: PMC9270611 DOI: 10.1016/j.jaccao.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sinha A, Bavishi A, Hibler EA, Yang EH, Parashar S, Okwuosa T, DeCara JM, Brown SA, Guha A, Sadler D, Khan SS, Shah SJ, Yancy CW, Akhter N. Interconnected Clinical and Social Risk Factors in Breast Cancer and Heart Failure. Front Cardiovasc Med 2022; 9:847975. [PMID: 35669467 PMCID: PMC9163546 DOI: 10.3389/fcvm.2022.847975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022] Open
Abstract
Breast cancer and heart failure share several known clinical cardiovascular risk factors, including age, obesity, glucose dysregulation, cholesterol dysregulation, hypertension, atrial fibrillation and inflammation. However, to fully comprehend the complex interplay between risk of breast cancer and heart failure, factors attributed to both biological and social determinants of health must be explored in risk-assessment. There are several social factors that impede implementation of prevention strategies and treatment for breast cancer and heart failure prevention, including socioeconomic status, neighborhood disadvantage, food insecurity, access to healthcare, and social isolation. A comprehensive approach to prevention of both breast cancer and heart failure must include assessment for both traditional clinical risk factors and social determinants of health in patients to address root causes of lifestyle and modifiable risk factors. In this review, we examine clinical and social determinants of health in breast cancer and heart failure that are necessary to consider in the design and implementation of effective prevention strategies that altogether reduce the risk of both chronic diseases
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Abdelfattah OM, Sayed AS, Munir M, Shazly O, Awad AK, Ghaith HS, Gerew M, Guha A, Barac A, Fradley MG, Abela GS, Addison D. Effectiveness of empiric cardioprotective therapy in patients receiving cardiotoxic chemotherapies: systematic review & bayesian network meta-analysis. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardioprotective therapies represent an important avenue to reduce these limiting toxicities, including serious heart failure (HF) events. However, due to conflicting isolated reports, the true efficacy and optimal cardioprotective therapy at the time of anticancer treatment initiation is unclear. Therefore, we undertook a network meta-analysis to elucidate the most effective therapies at cardiotoxic HF prevention.
Purpose
To determine the efficacy, and optimal cardioprotective strategy in patients receiving cardiotoxic chemotherapies.
Methods
Leveraging the MEDLINE/Pubmed, CENTRAL, and clinicaltrials.gov databases, we identified all randomized controlled trials (RCTs) investigating cardioprotective therapies from inception to November 2021. Eligible cardioprotective classes included ACEIs, ARBs, Beta-blockers, dexrazoxane (DEX), statins, and mineralocorticoid receptor antagonists (MRA). The primary endpoint was the prevention of new-onset HF. The secondary outcomes were the mean difference in left ventricular ejection fraction (LVEF) change, the incidence of hypotension, and all-cause mortality. Network meta-analyses were used to assess the cardioprotective effects of each therapy to deduce the most effective therapies. Both analyses were undertaken using a Bayesian random-effects model to estimate risk ratios (RR) and 95% credible intervals (95% CrI).
Results
Overall, from 726 articles, 39 studies evaluating 5,931 participants (38.0±19.1 years, 72.0% females) were identified. Over a median follow-up of 6 months, use of any cardioprotective strategy was associated with a significant reduction in new-onset HF (RR:0.32; 95% CrI:0.19-0.55), improved LVEF (mean difference: 3.92%; 95% CrI:2.81-5.07), and increased hypotension (RR:3.27; 95% CrI:1.38-9.87); there was no difference in mortality (RR:1.03; 95% CrI:0.84-1.22). Based on the median risk of incident HF in the control groups being 3.28%, the number need to treat (NNT) for "any" cardioprotective therapy to prevent one incident HF event was 45 patients. For dexrazoxane and neurohormonal agents, the median NNT was 36 and 53 patients, respectively. In this network analysis, dexrazoxane was most effective at HF prevention [Surface Under the Cumulative Ranking curve (SUCRA): 81.47%] and MRA most effective at preserving LVEF (SUCRA: 99.22%). ARBs most greatly increased hypotension (RR:7.20; 95% CrI:2.46-26.94).
Conclusion
Cardiotoxicity remains a challenge for cancer patients requiring life-saving cancer therapies. The initiation of a cardioprotective strategy reduces incident HF. Additional head-to-head trials are needed to confirm the optimal preventative strategy.
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Sayed A, Abdelfattah OM, Munir M, Shazly O, Awad AK, Ghaith HS, Moustafa K, Gerew M, Guha A, Barac A, Fradley MG, Abela GS, Addison D. Long-term effectiveness of empiric cardio-protection in patients receiving cardiotoxic chemotherapies: A systematic review & bayesian network meta-analysis. Eur J Cancer 2022; 169:82-92. [PMID: 35524992 DOI: 10.1016/j.ejca.2022.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cardioprotective therapies represent an important avenue to reduce treatment-limiting cardiotoxicities in patients receiving chemotherapy. However, the optimal duration, strategy and long-term efficacy of empiric cardio-protection remains unknown. METHODS Leveraging the MEDLINE/Pubmed, CENTRAL and clinicaltrials.gov databases, we identified all randomised controlled trials investigating cardioprotective therapies from inception to November 2021 (PROSPERO-ID:CRD42021265006). Cardioprotective classes included ACEIs, ARBs, Beta-blockers, dexrazoxane (DEX), statins and mineralocorticoid receptor antagonists. The primary end-point was new-onset heart failure (HF). Secondary outcomes were the mean difference in left ventricular ejection fraction (LVEF) change, hypotension and all-cause mortality. Network meta-analyses were used to assess the cardioprotective effects of each therapy to deduce the most effective therapies. Both analyses were performed using a Bayesian random effects model to estimate risk ratios (RR) and 95% credible intervals (95% CrI). RESULTS Overall, from 726 articles, 39 trials evaluating 5931 participants (38.0 ± 19.1 years, 72.0% females) were identified. The use of any cardioprotective strategy associated with reduction in new-onset HF (RR:0.32; 95% CrI:0.19-0.55), improved LVEF (mean difference: 3.92%; 95% CrI:2.81-5.07), increased hypotension (RR:3.27; 95% CrI:1.38-9.87) and no difference in mortality. Based on control arms, the number-needed-to-treat for 'any' cardioprotective therapy to prevent one incident HF event was 45, including a number-needed-to-treat of 21 with ≥1 year of therapy. Dexrazoxane was most effective at HF prevention (Surface Under the Cumulative Ranking curve: 81.47%), and mineralocorticoid receptor antagonists were most effective at preserving LVEF (Surface Under the Cumulative Ranking curve: 99.22%). CONCLUSION Cardiotoxicity remains a challenge for patients requiring anticancer therapies. The initiation of extended duration cardioprotection reduces incident HF. Additional head-to-head trials are needed.
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Clark KA, Reinhardt S, Chouairi F, Miller E, Kay B, Fuery M, Guha A, Ahmad T, Desai NR. Contemporary US Trends In Heart Transplantation And LVAD Index Hospitalizations: Volumes Increase, Utilization And Cost Vary Over Time, 2015-2018. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yousefzai R, Ahsan S, Chavez M, Castro M, Bakare O, Graviss E, Nguyen D, Suarez E, MacGillivray T, Kassi M, Kim J, Hussain I, Bhimaraj A, Guha A. Right Ventricular Failure and Left Ventricular Transmural Pressure as Predictors of Successful Left Ventricular Unloading in Patients with HM 3 CF-LVAD. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kumar S, Lin H, Derbala M, Chen N, Ferrall J, Cefalu M, Nguyen D, Graviss E, Goldstein D, Jorde U, Bhimaraj A, Suarez E, Sims D, Smith S, Li M, Guha A. Machine Learning Defines Distinct Phenotypes of Patients Developing Post-LVAD RVF in a Multi-Institutional Retrospective Cohort. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Cooper M, Krisl J, Guha A. Clinical Outcomes of 32 Heart Transplant Recipients Following Treatment of Antibody-Mediated Rejection Treatment: A Single-Center, Descriptive Study. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Reinhardt SW, Clark K, Chouairi F, Miller E, Kay B, Fuery M, Guha A, Ahmad T, Desai N. Trends In US Heart Failure Hospitalizations: Increased Volume And Patient Diversity With Decreased Total Costs, 2008-2018. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kassi M, Minhas A, Khan S, Shah A, Yousafzai R, Guha A, Bhimaraj A. Sex-Based Differences in Clinical Outcomes of Stroke Related to LVAD. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Guha A, Alonso A, Addison D. The association of atrial fibrillation with mortality in patients with breast cancer: author reply. Eur Heart J 2022; 43:1269-1270. [PMID: 35089995 PMCID: PMC9127718 DOI: 10.1093/eurheartj/ehac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
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Buck B, Chum A, Patel M, Carter RR, Nawaz H, Yildiz V, Ruiz P, Wiczer T, Rogers K, Awan F, Bhat S, Guha A, Kittai A, Simonetti OP, Raman SV, Wallace G, Sanchez R, Bonsu J, Gambril JA, Haddad D, Mann J, Wei L, Byrd J, Woyach J, Addison D. MYOCARDIAL INJURY AFTER IBRUTINIB INITIATION FOR HEMATOLOGIC MALIGNANCIES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02929-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Madan N, Lucas J, Akhter N, Collier P, Cheng F, Guha A, Zhang L, Sharma A, Hamid A, Ndiokho I, Wen E, Garster NC, Scherrer-Crosbie M, Brown SA. Artificial intelligence and imaging: Opportunities in cardio-oncology. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 15:100126. [PMID: 35693323 PMCID: PMC9187287 DOI: 10.1016/j.ahjo.2022.100126] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 12/29/2022]
Abstract
Cardiovascular disease is a leading cause of death in cancer survivors. It is critical to apply new predictive and early diagnostic methods in this population, as this can potentially inform cardiovascular treatment and surveillance decision-making. We discuss the application of artificial intelligence (AI) technologies to cardiovascular imaging in cardio-oncology, with a particular emphasis on prevention and targeted treatment of a variety of cardiovascular conditions in cancer patients. Recently, the use of AI-augmented cardiac imaging in cardio-oncology is gaining traction. A large proportion of cardio-oncology patients are screened and followed using left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), currently obtained using echocardiography. This use will continue to increase with new cardiotoxic cancer treatments. AI is being tested to increase precision, throughput, and accuracy of LVEF and GLS, guide point-of-care image acquisition, and integrate imaging and clinical data to optimize the prediction and detection of cardiac dysfunction. The application of AI to cardiovascular magnetic resonance imaging (CMR), computed tomography (CT; especially coronary artery calcium or CAC scans), single proton emission computed tomography (SPECT) and positron emission tomography (PET) imaging acquisition is also in early stages of analysis for prediction and assessment of cardiac tumors and cardiovascular adverse events in patients treated for childhood or adult cancer. The opportunities for application of AI in cardio-oncology imaging are promising, and if availed, will improve clinical practice and benefit patient care.
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Kocarnik JM, Compton K, Dean FE, Fu W, Gaw BL, Harvey JD, Henrikson HJ, Lu D, Pennini A, Xu R, Ababneh E, Abbasi-Kangevari M, Abbastabar H, Abd-Elsalam SM, Abdoli A, Abedi A, Abidi H, Abolhassani H, Adedeji IA, Adnani QES, Advani SM, Afzal MS, Aghaali M, Ahinkorah BO, Ahmad S, Ahmad T, Ahmadi A, Ahmadi S, Ahmed Rashid T, Ahmed Salih Y, Akalu GT, Aklilu A, Akram T, Akunna CJ, Al Hamad H, Alahdab F, Al-Aly Z, Ali S, Alimohamadi Y, Alipour V, Aljunid SM, Alkhayyat M, Almasi-Hashiani A, Almasri NA, Al-Maweri SAA, Almustanyir S, Alonso N, Alvis-Guzman N, Amu H, Anbesu EW, Ancuceanu R, Ansari F, Ansari-Moghaddam A, Antwi MH, Anvari D, Anyasodor AE, Aqeel M, Arabloo J, Arab-Zozani M, Aremu O, Ariffin H, Aripov T, Arshad M, Artaman A, Arulappan J, Asemi Z, Asghari Jafarabadi M, Ashraf T, Atorkey P, Aujayeb A, Ausloos M, Awedew AF, Ayala Quintanilla BP, Ayenew T, Azab MA, Azadnajafabad S, Azari Jafari A, Azarian G, Azzam AY, Badiye AD, Bahadory S, Baig AA, Baker JL, Balakrishnan S, Banach M, Bärnighausen TW, Barone-Adesi F, Barra F, Barrow A, Behzadifar M, Belgaumi UI, Bezabhe WMM, Bezabih YM, Bhagat DS, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhaskar S, Bhattacharyya K, Bhojaraja VS, Bibi S, Bijani A, Biondi A, Bisignano C, Bjørge T, Bleyer A, Blyuss O, Bolarinwa OA, Bolla SR, Braithwaite D, Brar A, Brenner H, Bustamante-Teixeira MT, Butt NS, Butt ZA, Caetano dos Santos FL, Cao Y, Carreras G, Catalá-López F, Cembranel F, Cerin E, Cernigliaro A, Chakinala RC, Chattu SK, Chattu VK, Chaturvedi P, Chimed-Ochir O, Cho DY, Christopher DJ, Chu DT, Chung MT, Conde J, Cortés S, Cortesi PA, Costa VM, Cunha AR, Dadras O, Dagnew AB, Dahlawi SMA, Dai X, Dandona L, Dandona R, Darwesh AM, das Neves J, De la Hoz FP, Demis AB, Denova-Gutiérrez E, Dhamnetiya D, Dhimal ML, Dhimal M, Dianatinasab M, Diaz D, Djalalinia S, Do HP, Doaei S, Dorostkar F, dos Santos Figueiredo FW, Driscoll TR, Ebrahimi H, Eftekharzadeh S, El Tantawi M, El-Abid H, Elbarazi I, Elhabashy HR, Elhadi M, El-Jaafary SI, Eshrati B, Eskandarieh S, Esmaeilzadeh F, Etemadi A, Ezzikouri S, Faisaluddin M, Faraon EJA, Fares J, Farzadfar F, Feroze AH, Ferrero S, Ferro Desideri L, Filip I, Fischer F, Fisher JL, Foroutan M, Fukumoto T, Gaal PA, Gad MM, Gadanya MA, Gallus S, Gaspar Fonseca M, Getachew Obsa A, Ghafourifard M, Ghashghaee A, Ghith N, Gholamalizadeh M, Gilani SA, Ginindza TG, Gizaw ATT, Glasbey JC, Golechha M, Goleij P, Gomez RS, Gopalani SV, Gorini G, Goudarzi H, Grosso G, Gubari MIM, Guerra MR, Guha A, Gunasekera DS, Gupta B, Gupta VB, Gupta VK, Gutiérrez RA, Hafezi-Nejad N, Haider MR, Haj-Mirzaian A, Halwani R, Hamadeh RR, Hameed S, Hamidi S, Hanif A, Haque S, Harlianto NI, Haro JM, Hasaballah AI, Hassanipour S, Hay RJ, Hay SI, Hayat K, Heidari G, Heidari M, Herrera-Serna BY, Herteliu C, Hezam K, Holla R, Hossain MM, Hossain MBH, Hosseini MS, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsairi M, Huang J, Hugo FN, Hussain R, Hussein NR, Hwang BF, Iavicoli I, Ibitoye SE, Ida F, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Irham LM, Islam JY, Islam RM, Islam SMS, Ismail NE, Isola G, Iwagami M, Jacob L, Jain V, Jakovljevic MB, Javaheri T, Jayaram S, Jazayeri SB, Jha RP, Jonas JB, Joo T, Joseph N, Joukar F, Jürisson M, Kabir A, Kahrizi D, Kalankesh LR, Kalhor R, Kaliyadan F, Kalkonde Y, Kamath A, Kameran Al-Salihi N, Kandel H, Kapoor N, Karch A, Kasa AS, Katikireddi SV, Kauppila JH, Kavetskyy T, Kebede SA, Keshavarz P, Keykhaei M, Khader YS, Khalilov R, Khan G, Khan M, Khan MN, Khan MAB, Khang YH, Khater AM, Khayamzadeh M, Kim GR, Kim YJ, Kisa A, Kisa S, Kissimova-Skarbek K, Kopec JA, Koteeswaran R, Koul PA, Koulmane Laxminarayana SL, Koyanagi A, Kucuk Bicer B, Kugbey N, Kumar GA, Kumar N, Kumar N, Kurmi OP, Kutluk T, La Vecchia C, Lami FH, Landires I, Lauriola P, Lee SW, Lee SWH, Lee WC, Lee YH, Leigh J, Leong E, Li J, Li MC, Liu X, Loureiro JA, Lunevicius R, Magdy Abd El Razek M, Majeed A, Makki A, Male S, Malik AA, Mansournia MA, Martini S, Masoumi SZ, Mathur P, McKee M, Mehrotra R, Mendoza W, Menezes RG, Mengesha EW, Mesregah MK, Mestrovic T, Miao Jonasson J, Miazgowski B, Miazgowski T, Michalek IM, Miller TR, Mirzaei H, Mirzaei HR, Misra S, Mithra P, Moghadaszadeh M, Mohammad KA, Mohammad Y, Mohammadi M, Mohammadi SM, Mohammadian-Hafshejani A, Mohammed S, Moka N, Mokdad AH, Molokhia M, Monasta L, Moni MA, Moosavi MA, Moradi Y, Moraga P, Morgado-da-Costa J, Morrison SD, Mosapour A, Mubarik S, Mwanri L, Nagarajan AJ, Nagaraju SP, Nagata C, Naimzada MD, Nangia V, Naqvi AA, Narasimha Swamy S, Ndejjo R, Nduaguba SO, Negoi I, Negru SM, Neupane Kandel S, Nguyen CT, Nguyen HLT, Niazi RK, Nnaji CA, Noor NM, Nuñez-Samudio V, Nzoputam CI, Oancea B, Ochir C, Odukoya OO, Ogbo FA, Olagunju AT, Olakunde BO, Omar E, Omar Bali A, Omonisi AEE, Ong S, Onwujekwe OE, Orru H, Ortega-Altamirano DV, Otstavnov N, Otstavnov SS, Owolabi MO, P A M, Padubidri JR, Pakshir K, Pana A, Panagiotakos D, Panda-Jonas S, Pardhan S, Park EC, Park EK, Pashazadeh Kan F, Patel HK, Patel JR, Pati S, Pattanshetty SM, Paudel U, Pereira DM, Pereira RB, Perianayagam A, Pillay JD, Pirouzpanah S, Pishgar F, Podder I, Postma MJ, Pourjafar H, Prashant A, Preotescu L, Rabiee M, Rabiee N, Radfar A, Radhakrishnan RA, Radhakrishnan V, Rafiee A, Rahim F, Rahimzadeh S, Rahman M, Rahman MA, Rahmani AM, Rajai N, Rajesh A, Rakovac I, Ram P, Ramezanzadeh K, Ranabhat K, Ranasinghe P, Rao CR, Rao SJ, Rawassizadeh R, Razeghinia MS, Renzaho AMN, Rezaei N, Rezaei N, Rezapour A, Roberts TJ, Rodriguez JAB, Rohloff P, Romoli M, Ronfani L, Roshandel G, Rwegerera GM, S M, Sabour S, Saddik B, Saeed U, Sahebkar A, Sahoo H, Salehi S, Salem MR, Salimzadeh H, Samaei M, Samy AM, Sanabria J, Sankararaman S, Santric-Milicevic MM, Sardiwalla Y, Sarveazad A, Sathian B, Sawhney M, Saylan M, Schneider IJC, Sekerija M, Seylani A, Shafaat O, Shaghaghi Z, Shaikh MA, Shamsoddin E, Shannawaz M, Sharma R, Sheikh A, Sheikhbahaei S, Shetty A, Shetty JK, Shetty PH, Shibuya K, Shirkoohi R, Shivakumar KM, Shivarov V, Siabani S, Siddappa Malleshappa SK, Silva DAS, Singh JA, Sintayehu Y, Skryabin VY, Skryabina AA, Soeberg MJ, Sofi-Mahmudi A, Sotoudeh H, Steiropoulos P, Straif K, Subedi R, Sufiyan MB, Sultan I, Sultana S, Sur D, Szerencsés V, Szócska M, Tabarés-Seisdedos R, Tabuchi T, Tadbiri H, Taherkhani A, Takahashi K, Talaat IM, Tan KK, Tat VY, Tedla BAA, Tefera YG, Tehrani-Banihashemi A, Temsah MH, Tesfay FH, Tessema GA, Thapar R, Thavamani A, Thoguluva Chandrasekar V, Thomas N, Tohidinik HR, Touvier M, Tovani-Palone MR, Traini E, Tran BX, Tran KB, Tran MTN, Tripathy JP, Tusa BS, Ullah I, Ullah S, Umapathi KK, Unnikrishnan B, Upadhyay E, Vacante M, Vaezi M, Valadan Tahbaz S, Velazquez DZ, Veroux M, Violante FS, Vlassov V, Vo B, Volovici V, Vu GT, Waheed Y, Wamai RG, Ward P, Wen YF, Westerman R, Winkler AS, Yadav L, Yahyazadeh Jabbari SH, Yang L, Yaya S, Yazie TSY, Yeshaw Y, Yonemoto N, Younis MZ, Yousefi Z, Yu C, Yuce D, Yunusa I, Zadnik V, Zare F, Zastrozhin MS, Zastrozhina A, Zhang J, Zhong C, Zhou L, Zhu C, Ziapour A, Zimmermann IR, Fitzmaurice C, Murray CJL, Force LM. Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol 2022; 8:420-444. [PMID: 34967848 PMCID: PMC8719276 DOI: 10.1001/jamaoncol.2021.6987] [Citation(s) in RCA: 624] [Impact Index Per Article: 312.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEW The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). FINDINGS In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCE The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.
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Prasad RN, McIntyre M, Guha A, Carter RR, Yildiz VO, Paskett E, Lustberg M, Ruz P, Williams TM, Kola-Kehinde O, Miller ED, Addison D. Cardiovascular Event Reporting in Modern Cancer Radiation Therapy Trials. Adv Radiat Oncol 2022; 7:100888. [PMID: 35198835 PMCID: PMC8844682 DOI: 10.1016/j.adro.2021.100888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/21/2021] [Indexed: 01/14/2023] Open
Abstract
Purpose Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in cancer survivors, particularly after chest radiation therapy (RT). However, the extent to which CVD events are consistently reported in contemporary prospective trials is unknown. Methods and Materials From 10 high-impact RT, oncology, and medicine journals, we identified all latter phase trials from 2000 to 2019 enrolling patients with breast, lung, lymphoma, mesothelioma, or esophageal cancer wherein chest-RT was delivered. The primary outcome was the report of major adverse cardiac events (MACEs), defined as incident myocardial infarction, heart failure, coronary revascularization, arrhythmia, stroke, or CVD death across treatment arms. The secondary outcome was the report of any CVD event. Multivariable regression was used to identify factors associated with CVD reporting. Pooled annualized incidence rates of MACEs across RT trials were compared with contemporary population rates using relative risks (RRs). Results The 108 trials that met criteria enrolled 59,070 patients (mean age, 58.0 ± 10.2 years; 46.0% female), with 273,587 person-years of available follow-up. During a median follow-up of 48 months, 468 MACEs were reported (including 96 heart failures, 75 acute coronary syndrome, 1 revascularization, 94 arrhythmias, 28 strokes, and 20 CVD deaths; 307 occurred in the intervention arms vs 144 in the control arms; RR, 1.96; P < .001). Altogether, 50.0% of trials did not report MACEs, and 37.0% did not report any CVD. The overall weighted-trial incidence was 376 events per 100,000 person-years compared with 1408 events per 100,000 person-years in similar nontrial patients (RR, 0.27; P < .001). There were no RT factors associated with CVD reporting. Conclusion In contemporary chest RT–based clinical trials, reported CVD rates were lower than expected population rates.
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