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Abdikarimov A, Bekenova A, Nurmakhan N, Shayakhmetov Y, Tuganbekov T. Simultaneous surgery for coexisting heart disease and non-cardiac malignancy: assessment of feasibility in case series. J Surg Case Rep 2024; 2024:rjae340. [PMID: 38817785 PMCID: PMC11138668 DOI: 10.1093/jscr/rjae340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
We present case series of simultaneous surgery for coexisting cardiac and non-cardiac pathologies to evaluate the feasibility of the treatment. The retrospective analysis included 27 patients aged between 28 and 74 years. The most often heart diseases were coronary arterial disease and valve defects, and the most often heart surgery was coronary artery bypass grafting. The non-cardiac diseases included neoplasms in the abdominal cavity, urinary system, and chest organs. The average duration of surgery was 277 ± 87 minutes, blood loss 285 ± 182 ml. The in-hospital mortality was 0%, with median stay of 2 and 12 days in the intensive care unit (ICU) and emergency room, respectively. The 1 and 5-year survival rates were 85.7% and 76.2%, respectively. Simultaneous surgeries can be a treatment of choice for patients with cardiac pathology and concomitant neoplasm in abdominal, thoracic, or urinary system. This is the first such study conducted in the Central-Asian region and, in particular, in Kazakhstan.
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Affiliation(s)
- Anuar Abdikarimov
- Department of General and Torasic Surgery, National Scientific Medical Center, 42 Abylai Khan ave., 010009, Astana, Kazakhstan
| | - Aigerim Bekenova
- School of Medicine, Nazarbayev University School of Medicine, 5/1 Kerey and Zhanibek Khandar str., 020000, Astana, Kazakhstan
| | - Nazerke Nurmakhan
- Astana Medical University, 49/A Beibitshilik str., 010000, Astana, Kazakhstan
| | - Yerzhan Shayakhmetov
- Tomotherapy Department, International Tomotherapy Center “UMIT”, 42/1 Abylai Khan ave., 010000, Astana, Kazakhstan
| | - Turlybek Tuganbekov
- Astana Medical University, 49/A Beibitshilik str., 010000, Astana, Kazakhstan
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Carbone A, Bottino R, D’Andrea A, Russo V. Direct Oral Anticoagulants for Stroke Prevention in Special Populations: Beyond the Clinical Trials. Biomedicines 2023; 11:biomedicines11010131. [PMID: 36672639 PMCID: PMC9856013 DOI: 10.3390/biomedicines11010131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Currently, direct oral anticoagulants (DOACs) are the first-line anticoagulant strategy in patients with non-valvular atrial fibrillation (NVAF). They are characterized by a more favorable pharmacological profile than warfarin, having demonstrated equal efficacy in stroke prevention and greater safety in terms of intracranial bleeding. The study population in the randomized trials of DOACs was highly selected, so the results of these trials cannot be extended to specific populations such as obese, elderly, frail, and cancer patients, which, on the other hand, are sub-populations widely represented in clinical practice. Furthermore, due to the negative results of DOAC administration in patients with mechanical heart valves, the available evidence in subjects with biological heart valves is still few and often controversial. We sought to review the available literature on the efficacy and safety of DOACs in elderly, obese, underweight, frail, cancer patients, and in patients with bioprosthetic heart valves with NVAF to clarify the best anticoagulant strategy in these special and poorly studied subpopulations.
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Affiliation(s)
- Andreina Carbone
- Department of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Roberta Bottino
- Department of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Antonello D’Andrea
- Unit of Cardiology and Intensive Coronary Care, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy
| | - Vincenzo Russo
- Department of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Monaldi Hospital, P.zzale Ettore Ruggeri, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-5665144
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Han H, Chen L, Lin Z, Wei X, Guo W, Yu Y, Wu C, Cao Y, He J. Prevalence, trends, and outcomes of atrial fibrillation in hospitalized patients with metastatic cancer: findings from a national sample. Cancer Med 2021; 10:5661-5670. [PMID: 34235874 PMCID: PMC8366074 DOI: 10.1002/cam4.4105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/08/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Epidemiological evidence regarding the link between cancer and atrial fibrillation (AF) are limited and outcomes of metastatic cancer comorbid with AF need to be elucidated. OBJECTIVE This study aims to evaluate the prevalence, temporal trends, and outcomes of AF in hospitalized metastatic cancer patients. METHODS The National Inpatient Sample (NIS) database was used to identify adult patients with metastatic tumors from 2003 to 2014. We analyzed the trends in AF prevalence, in-hospital mortality, total cost, length of stay (LOS), and comorbidities pertaining to metastatic cancer. Multivariable-adjusted models were used to evaluate the association of AF with clinical factors, in-hospital mortality, total cost, and LOS. RESULTS Among 2,478,598 patients with metastatic cancer, 8.74% (216,737) were diagnosed with AF. The proportion of comorbid AF increased from 8.28% in 2003 to 10.06% in 2014 (p < 0.0001). Older age, white race, male, Medicare, higher income, larger hospital bed size, and urban teaching hospital were associated with higher AF occurrence. Among primary tumor sites, lung cancer experienced the highest odds of AF compared to other cancers. Patients with metastasis to lymph node and respiratory organ had higher odds of AF. In metastatic cancer, AF was associated with higher in-hospital mortality (odds ratio: 1.48; 95% confidence interval: 1.43-1.54), 18% longer LOS, and 19% higher cost. CONCLUSIONS AF prevalence in metastatic cancer continues to increase from 2003 to 2014. AF is linked to poorer prognosis and higher healthcare resource utilization. As the population ages, optimal preventive and treatment management strategies are needed for metastatic cancer comorbid with AF.
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Affiliation(s)
- Hedong Han
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Longpei Chen
- Department of Medical Oncology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhen Lin
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Xin Wei
- Department of Cardiology, Virginia Commonwealth University, Richmond, VA, USA.,Department of Medicine, Mount Sinai St. Luke's and West Medical Center, New York, NY, USA
| | - Wei Guo
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Yamei Yu
- Department of Cardiology, Shanghai Changning District Central Hospital, Shanghai, China
| | - Cheng Wu
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jia He
- Department of Health Statistics, Second Military Medical University, Shanghai, China.,Department of Health Statistics, Tongji University School of Medicine, Shanghai, China
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Milazzo V, Cosentino N, Campodonico J, Lucci C, Cardinale D, Cipolla CM, Marenzi G. Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer. J Clin Med 2020; 9:E3642. [PMID: 33198355 PMCID: PMC7696544 DOI: 10.3390/jcm9113642] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
Patients with cancer are at increased risk of cardiovascular disease, with a reported prevalence of acute coronary syndrome (ACS) ranging from 3% to 17%. The increased risk of ACS in these patients seems to be due to the complex interaction of shared cardiovascular risk factors, cancer type and stage, and chemotherapeutic and radiotherapy regimens. The management of ACS in patients with cancer is a clinical challenge, particularly due to cancer's unique pathophysiology, which makes it difficult to balance thrombotic and bleeding risks in this specific patient population. In addition, patients with cancer have largely been excluded from ACS trials. Hence, an evidence-based treatment for ACS in this group of patients is unknown and only a limited proportion of them is treated with antiplatelets or invasive revascularization, despite initial reports suggesting their beneficial prognostic effects in cancer patients. Finally, cancer patients experiencing ACS are also at higher risk of in-hospital and long-term mortality as compared to non-cancer patients. In this review, we will provide an overview on the available evidence of the relationship between ACS and cancer, in terms of clinical manifestations, possible underlying mechanisms, and therapeutic and prognostic implications.
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Affiliation(s)
- Valentina Milazzo
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.M.); (N.C.); (J.C.); (C.L.)
| | - Nicola Cosentino
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.M.); (N.C.); (J.C.); (C.L.)
| | - Jeness Campodonico
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.M.); (N.C.); (J.C.); (C.L.)
| | - Claudia Lucci
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.M.); (N.C.); (J.C.); (C.L.)
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Carlo M. Cipolla
- Cardiology Division, European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.M.); (N.C.); (J.C.); (C.L.)
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Caturano A, Galiero R, Pafundi PC. Atrial Fibrillation and Stroke. A Review on the Use of Vitamin K Antagonists and Novel Oral Anticoagulants. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E617. [PMID: 31547188 PMCID: PMC6843417 DOI: 10.3390/medicina55100617] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/01/2019] [Accepted: 09/13/2019] [Indexed: 01/17/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia, ranging from 0.1% in patients <55 years to >9% in octogenarian patients. One important issue is represented by the 5-fold increased ischemic stroke risk in AF patients. Hence, the role of anticoagulation is central. Until a few years ago, vitamin K antagonists (VKAs) and low molecular weight heparin represented the only option to prevent thromboembolisms, though with risks. Novel oral anticoagulants (NOACs) have radically changed the management of AF patients, improving both life expectancy and life quality. This review aims to summarize the most recent literature on the use of VKAs and NOACs in AF, in light of the new findings.
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Affiliation(s)
- Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, IT-80138 Naples, Italy.
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, IT-80138 Naples, Italy.
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, IT-80138 Naples, Italy.
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Clark RA, Marin TS, McCarthy AL, Bradley J, Grover S, Peters R, Karapetis CS, Atherton JJ, Koczwara B. Cardiotoxicity after cancer treatment: a process map of the patient treatment journey. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2019; 5:14. [PMID: 32154020 PMCID: PMC7048085 DOI: 10.1186/s40959-019-0046-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/24/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIM Cardiotoxicity is a potential complication of anticancer therapy. While guidelines have been developed to assist practitioners, an effective, evidence based clinical pathway for the treatment of cardiotoxicity has not yet been developed. The aim of this study was to describe the journey of patients who developed cardiotoxicity through the healthcare system in order to establish baseline data to inform the development and implementation of a patient-centred, evidence-based clinical pathway. METHODS Mixed-methods design with quantitative and qualitative components using process mapping at 3 large medical centres in 2 states between 2010 and 2015. RESULTS Fifty (50) confirmed cases of cardiotoxicity were reviewed (39 medical record reviews, 7 medical record review and interviews and 4 internview only). The mean age at cancer diagnosis of this group was 53.3 years (range 6-89 years); 50% female; 30% breast cancer, 23% non-Hodgkin's lymphoma; mean chemotherapy cycles 5.2 (median 6; range 1-18); 49 (89%) presented to chemotherapy with pre-existing cardiovascular risk factors; 39 (85%) had at least one modifiable risk factor and 11 (24%) had more than 4; 44 (96%) were diagnosed by echocardiogram and 27 (57%) were referred to a cardiologist (only 7 (15%) before chemotherapy). Post chemotherapy, 22 (48%) patients were referred to a multidisciplinary heart failure clinic; 8 (17%) to cardiac rehabilitation; 1 (2%) to cancer survivorship clinic and 10 (22%) to a palliative care service. There were 16 (34%) deaths during the timeframe of the study; 4 (25%) cardiac-related, 6 (38%) cancer-related, 4 (25%) due to sepsis and 2 (12%) other causes not recorded. The main concerns participants raised during the interviews were cancer professionals not discussing the potential for cardiotoxicity with them prior to treatment, nor risk modification strategies; a need for health education, particularly regarding risks for developing heart failure related to cancer treatment; and a lack of collaboration between oncologists and cardiologists. CONCLUSIONS Our results demonstrate that the clinical management of cancer patients with cardiotoxicity was variable and fragmented and not patient centered. This audit establishes practice gaps that can be addressed through the design of an evidence-based clinical pathway for cancer patients with, or at risk, of cardiotoxicity.
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Affiliation(s)
- Robyn A. Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Tania S. Marin
- Acute Care & Cardiovascular Research, College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Alexandra L. McCarthy
- Faculty of Health and Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Julie Bradley
- Royal Adelaide Hospital, North Terrace, Adelaide, SA Australia
| | - Suchi Grover
- Flinders Cardiac Clinic, Flinders Private Hospital, Bedford Park, Adelaide, SA Australia
| | - Robyn Peters
- Heart Recovery Service, Cardiology Department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld Australia
- The University of Queensland, St Lucia Campus, St Lucia, Qld Australia
| | - Christos S. Karapetis
- Department of Medical Oncology and Medical Oncology Clinical Research, Flinders Medical Centre, Flinders Drive, Bedford Park, SA Australia
- Southern Area Local Health Network, SA Health, Adelaide, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA Australia
| | - John J. Atherton
- Royal Brisbane and Women’s Hospital, University of Queensland School of Medicine, Butterfield St & Bowen Bridge Rd, Herston, Qld Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, Flinders Drive, Bedford Park, SA Australia
- Flinders University, Adelaide, SA Australia
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Sato T, Aizawa Y, Fuse K, Fujita S, Ikeda Y, Kitazawa H, Takahashi M, Okabe M. The Impact of Cancer on Major Bleeding and Stroke/Systemic Emboli in Patients Using Direct Oral Anticoagulants:From the Database of a Single-Center Registry. J Atr Fibrillation 2019; 11:2105. [PMID: 31139289 DOI: 10.4022/jafib.2105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/14/2017] [Accepted: 11/11/2018] [Indexed: 01/31/2023]
Abstract
Background Few data are available on direct oral anticoagulant (DOAC) use in patients with cancer and atrial fibrillation (AF). Methods We retrospectively analyzed prospectively collected data from a single-center registryon 2,272 patients who tookDOACs for AF (apixaban:1,014; edoxaban:267; rivaroxaban:498; dabigatran:493). Patients were monitored for 2 years andclassified into non-cancer (n=2009) and cancer group (n=263) (cancer onset during DOAC treatment, active canceratDOAC administration, and cancer history).Major bleeding (MB) and thromboembolic events (TEEs) were evaluated. Results The mean age was 73±10 years. CHADS2 and HAS-BLED scores were 1.95±1.32 and 1.89±0.96,respectively.In the present study, the prevalence of gastrointestinal and genitourinary cancer was 61% and 8%, respectively.The MB and TEEs incidences were 2.4 and 2.2 per 100-patient years, respectively. The appropriate dosing rate, body weight, and Ccrvalue in cancer patients were significantly lower than those in non-cancer patients. Cancer patients were significantly older than non-cancer patients. In MB patients diagnosed with gastrointestinal or genitourinary cancer during follow-up, the clinically relevant bleeding such as melena or hematuria occurred.Additionally, there was a significantly higher MB incidence in cancer patients than in non-cancer patients (p<0.01). Conclusions AF patients with cancer was associated with a higher risk of MB compared with those without cancer despite higher rate of inappropriate low dose. Bleeding such as melena and hematuria after DOAC administration might suggest that the symptoms are associated with cancer of the site.
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Affiliation(s)
- Takao Sato
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Yoshifusa Aizawa
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Koichi Fuse
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Satoshi Fujita
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Yoshio Ikeda
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Hitoshi Kitazawa
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Minoru Takahashi
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
| | - Masaaki Okabe
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
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Liu B, Chen C, Gu C, Li Q, Liu J, Pu Y, Lin Y, Wei Z, Li Z, Zhang Y. Combined Coronary Artery Bypass Graft (CABG) Surgery and Lung Resection for Lung Cancer in Patients More than 50 Years-of-Age. Med Sci Monit 2018; 24:3307-3314. [PMID: 29779035 PMCID: PMC5989628 DOI: 10.12659/msm.907545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The co-existence of coronary heart disease (CHD) and lung cancer is increasing in an increasingly aging population. The aim of this study was to evaluate patient outcome from combined off-pump coronary artery bypass graft (CABG) surgery and lung resection in patients more than 50 years-of-age. Material/Methods A retrospective clinical study of 23 patients with a mean age of 70.2±8.4 years (range, 51–86 years) included 18 men and five women with CHD and lung cancer who underwent a single operation with combined off-pump CABG surgery and lung resection, for non-small cell lung cancer (NSCLC) (n=22) and small cell lung cancer (n=1). Surgical approaches included: median sternotomy in six patients; left lateral thoracotomy in nine patients; a median sternotomy in three patients; median sternotomy combined with thoracoscopic lobectomy in five patients. Results In the retrospective study of 23 patients, there were no deaths and no new cases of myocardial infarction (MI) in the immediate perioperative period. During the follow-up period, six patients died from lung cancer metastasis or recurrence; one patient died of acute renal failure; and one patient died from the effects of chemotherapy. The remaining 15 patients underwent postoperative follow-up for between 3–79 months with no deaths and no new cases of MI. Conclusions For patients who are more than 50 years-of-age and who have CHD and lung cancer, a single combined operation that includes off-pump CABG and lung resection can be safe and effective.
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Affiliation(s)
- Ban Liu
- Department of Cardiology, Shanghai Tenth Peoples' Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Chao Chen
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, Chile
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Qianfan Li
- Department of Cardiothoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jingjing Liu
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yiwei Pu
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Yu Lin
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zilun Wei
- The First Clinical Medical Department of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zhi Li
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Yangyang Zhang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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The unrecognized role of tumor suppressor genes in atrial fibrillation. Gene 2018; 642:26-31. [DOI: 10.1016/j.gene.2017.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/25/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023]
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10
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Hu WS, Lin CL. Comparison of CHA 2 DS 2 -VASc, CHADS 2 and HATCH scores for the prediction of new-onset atrial fibrillation in cancer patients: A nationwide cohort study of 760,339 study participants with competing risk analysis. Atherosclerosis 2017; 266:205-211. [DOI: 10.1016/j.atherosclerosis.2017.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/24/2017] [Accepted: 10/05/2017] [Indexed: 01/15/2023]
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Liu B, Gu C, Wang Y, Wang X, Ge W, Shan L, Wei Y, Xu X, Zhang Y. Feasibility and efficacy of simultaneous off-pump coronary artery bypass grafting and esophagectomy in elderly patients. Oncotarget 2017; 8:46498-46505. [PMID: 28148891 PMCID: PMC5542285 DOI: 10.18632/oncotarget.14824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/17/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION To analyze the outcomes of off-pump coronary artery bypass grafting (OPCABG) and esophagectomy simultaneously for patients with coronary artery disease (CAD) and coexisting esophageal cancer. METHODS Twenty-two patients with CAD and coexisting esophageal cancer underwent combined surgical interventions were subjected to the study. OPCABG was performed first, followed by esophagectomy. All the corresponding data including clinicopathological characteristics and postoperative outcomes were all investigated. RESULTS All the combined procedures were performed successfully. The average number of grafts was 2.36. Tumors were located at the middle third of the esophagus in 5 patients, at the lower third of the esophagus in 8 patients, at the esophageal gastric junction (EGJ) in 9 patients, respectively. The operations were carried out through a left lateral thoracotomy approach in 21 patients while a median sternotomy and left lateral thoracotomy approach was used in 1 patient for his condition rapidly worsened. Postoperatively, pneumonia occurred in 4 patients (18.2%). During the follow-up, three patients died of cancer metastasis /recurrence (6, 18, 37 months) and one died of pneumonia (1 month). The cumulative 5 years survival rate is 52.9%. CONCLUSIONS The combined procedure of OPCABG and esophagectomy is a safe and effective treatment option for patients with severe CAD and esophageal cancer.
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Affiliation(s)
- Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuliang Wang
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaowei Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Wen Ge
- Department of Cardiovascular Surgery, Shuguang Hospital, Affiliated to Shanghai University of TCM, Shanghai, China
| | - Lingtong Shan
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Yujian Wei
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Xiaohan Xu
- Department of Cardiovascular Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China
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Abstract
BACKGROUND Cardiovascular disease (CVD) is of increasing concern among breast cancer survivors. However, the burden of this comorbidity in this group relative to the general population, and its temporal pattern, remains unknown. METHODS We compared deaths due to CVD in a population-based sample of 1,413 women with incident breast cancer diagnosed in 1996-1997, and 1,411 age-matched women without breast cancer. Date and cause of death through December 31, 2009 were assessed through the national death index and covariate data was gathered through structured interviews and medical record abstraction. Hazard ratios (HR) and 95% confidence intervals were calculated using Cox regression for overall mortality (HR) and CVD-specific death (cause-specific HR). Subdistribution HRs for CVD death were estimated from the Fine-Gray model. RESULTS Risk of death was greater among breast cancer survivors compared with women without breast cancer (HR: 1.8 [1.5, 2.1]). An increase in CVD-related death among breast cancer survivors was evident only 7 years after diagnosis (years 0-7, cause-specific HR: 0.80 [0.53, 1.2], subdistribution HR: 0.59 [0.40, 0.87]); years 7+, cause-specific HR: 1.8 [1.3, 2.5], subdistribution HR: 1.9 [1.4, 2.7]; P interaction: 0.001). An increase in CVD-related mortality was observed among breast cancer survivors receiving chemotherapy. CONCLUSIONS Breast cancer survivors are at greater risk for CVD-related mortality compared with women without breast cancer and this increase in risk is manifested approximately 7 years after diagnosis. Efforts should be made to identify risk factors and interventions that can be employed during this brief window to reduce the excess burden of CVD in this vulnerable population.
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13
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Zheng Y, Chen H, Li X, Sun Y. Pay attention to cardiac remodeling in cancer cachexia. Support Care Cancer 2016; 24:3253-9. [PMID: 27108265 DOI: 10.1007/s00520-016-3222-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/17/2016] [Indexed: 01/21/2023]
Abstract
Cancer cachexia is a complex and multifaceted disease state characterized by fatigue, weakness, and loss of skeletal muscle and adipose tissue. Recently, the profound negative effects of cancer cachexia on cardiac tissue draw much attention, which is likely to contribute to mortality in tumor-bearing animals. The mechanism of cardiac remodeling is not so clear and involved with a series of molecular alterations. In cancer cachexia model, progressive loss of left ventricular mass and decrease in myocardial function is observed and cardiac autonomic functions are altered. Levels of several emerging cardiovascular neurohormones are found elevating in patients with cancer, but it is still controversial whether the changes could reflect the heart injury accurately. The remedy for cardiac remodeling has been explored. It is showed that exercise can modulate signaling pathways activated by wasting cytokines and impact on the resulting outcomes on heart adaptation. Some drugs, such as bisoprolol, spironolactone, perindopril, tandospirone, and simvastatin, can mitigate adverse effects of the tumor on the heart and prolong survival.
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Affiliation(s)
- Yawen Zheng
- Department of Oncology, Jinan Central Hospital, Shandong University, No. 105, Jie Fang Road, Jinan, Shandong, 250013, People's Republic of China
| | - Han Chen
- Soochow University College of Medicine, Suzhou, Jiangsu, 215000, China
| | - Xiaoqing Li
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310029, China
| | - Yuping Sun
- Department of Oncology, Jinan Central Hospital, Shandong University, No. 105, Jie Fang Road, Jinan, Shandong, 250013, People's Republic of China.
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14
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Wieshammer S, Dreyhaupt J, Müller D, Momm F, Jakob A. Limitations of N-Terminal Pro-B-Type Natriuretic Peptide in the Diagnosis of Heart Disease among Cancer Patients Who Present with Cardiac or Pulmonary Symptoms. Oncology 2016; 90:143-50. [PMID: 26871423 DOI: 10.1159/000443505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/18/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Recognizing heart disease is relevant to oncologists because cancer patients are at an increased risk of cardiac mortality due to shared risk factors and the adverse effects of cancer therapy. This study assessed the extent to which the measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP) aids in the diagnosis of heart disease in addition to a history of coronary artery disease and the presence of atrial fibrillation (composite test). The NT- proBNP cutoff value was 100 pg/ml. METHODS A series of 583 consecutive cancer patients (68.4 ± 11.0 years) who were referred because of cardiac or pulmonary symptoms prospectively underwent a diagnostic work-up. Heart disease was diagnosed if at least one of the following conditions was present: (a) history of coronary artery disease, (b) atrial fibrillation, (c) impaired left ventricular systolic function, (d) significant valvular disease, (e) pulmonary hypertension, or (f) left ventricular hypertrophy. RESULTS Except for (a), all 6 conditions were associated with NT-proBNP >100 pg/ml. The sensitivity/specificity values of the composite test were 0.92/0.50 for any heart disease. Several extracardiac covariates were associated with NT-proBNP >100 pg/ml, which contributed to the low test specificity. CONCLUSIONS The low specificity of NT-proBNP limits its value for the diagnosis of heart disease in cancer patients.
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Affiliation(s)
- Siegfried Wieshammer
- Departments of Cardiology, Pulmonology and Critical Care Medicine, Radiation Oncology and Medical Oncology, Offenburg Hospital, Offenburg, and Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
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15
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Iliescu CA, Grines CL, Herrmann J, Yang EH, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas KP, Leesar MA, Marmagkiolis K. SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista). Catheter Cardiovasc Interv 2016; 87:E202-23. [PMID: 26756277 DOI: 10.1002/ccd.26379] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/28/2015] [Indexed: 12/24/2022]
Abstract
In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients.
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Affiliation(s)
- Cezar A Iliescu
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Cindy L Grines
- Detroit Medical Center, Cardiovascular Institute, Detroit, Michigan
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Eric H Yang
- Division of Cardiology, University of California at Los Angeles, Los Angeles, California
| | - Mehmet Cilingiroglu
- School of Medicine, Arkansas Heart Hospital, Little Rock, Arkansas.,Department of Cardiology, Koc University, Istanbul, Turkey
| | | | - Abdul Hakeem
- Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Massoud A Leesar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Konstantinos Marmagkiolis
- Department of Cardiology, Citizens Memorial Hospital, Bolivar, Missouri.,Department of Medicine, University of Missouri, Columbia, Missouri
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16
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Yang Y, Xiao F, Wang J, Song B, Li XH, Li J, He ZS, Zhang H, Yin L. Simultaneous surgery in patients with both cardiac and noncardiac diseases. Patient Prefer Adherence 2016; 10:1251-8. [PMID: 27486311 PMCID: PMC4957679 DOI: 10.2147/ppa.s100588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery. METHODS From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries. RESULTS Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG), bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%]), pulmonary infection and hypoxemia (2, 3.1%), hemorrhage of upper digestive tract (1, 1.6%), incisional infection (3, 4.7%), subphrenic abscess (1, 1.6%), and postoperative acute renal failure and hemofiltration (3, 4.7%). Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%. CONCLUSION Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible with satisfactory short-term and long-term survival.
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Affiliation(s)
- Yang Yang
- Department of Cardiac Surgery
- Correspondence: Yang Yang, Department of Cardiac Surgery, Peking University First Hospital, No 8 Xishiku Street, Beijing 100034, People’s Republic of China, Tel +86 10 8357 2744, Email
| | | | | | - Bo Song
- Department of Cardiac Surgery
| | | | - Jian Li
- Department of Thoracic Surgery
| | | | | | - Ling Yin
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s Republic of China
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17
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Møller T, Lillelund C, Andersen C, Bloomquist K, Christensen KB, Ejlertsen B, Nørgaard L, Wiedenbein L, Oturai P, Breitenstein U, Adamsen L. The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study. BMJ Open Sport Exerc Med 2015; 1:e000021. [PMID: 27900123 PMCID: PMC5117008 DOI: 10.1136/bmjsem-2015-000021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Anti-neoplastic treatment is synonymous with an inactive daily life for a substantial number of patients. It remains unclear what is the optimal setting, dosage and combination of exercise and health promoting components that best facilitate patient adherence and symptom management in order to support cardio-respiratory fitness and lifestyle changes in an at-risk population of pre-illness physically inactive cancer patients. Methods Patients with breast or colon cancer referred to adjuvant chemotherapy and by the oncologists pre-screening verified as physically inactive were eligible to enter a randomised three-armed feasibility study comparing a 12-week supervised hospital-based moderate to high intensity exercise intervention or alternate an instructive home-based12-week pedometer intervention, with usual care. Results Using a recommendation based physical activity screening instrument in order to correspond with cardio-respiratory fitness (VO2 peak) proved to be an applicable method to identify pre-illness physically inactive breast and colon cancer patients. The study demonstrated convincing recruitment (67%), safety and intervention adherence among breast cancer patients; while the attendance rate for colon cancer patients was notably lower (33%). VO2-peak declined on average 12% across study groups from baseline to 12 weeks though indices towards sustaining watt performance and reduce fat mass favoured the hospital-based intervention. Pedometer use was well adapted in both breast and colon cancer patients. Conclusions Despite a fair adherence and safety, the current study calls into question whether aerobic exercise, regardless of intensity, is able to increase VO2-peak during texane-based chemotherapy in combination with Neulasta in physically inactive breast cancer patients. Trial Registration: ISRCTN24901641
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Affiliation(s)
- Tom Møller
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Christian Lillelund
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Christina Andersen
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Kira Bloomquist
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Karl Bang Christensen
- Faculty of Health and Medical Sciences, Section of Biostatistics , University of Copenhagen , Copenhagen , Denmark
| | - Bent Ejlertsen
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lone Nørgaard
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Liza Wiedenbein
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Ulla Breitenstein
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lis Adamsen
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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18
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Peruzzi M, Palazzoni G, Biondi-Zoccai G, Lotrionte M. Cardiotoxicity due to chemotherapy for breast cancer: the dark side of the moon. Anatol J Cardiol 2015; 15:61-2. [PMID: 25550249 PMCID: PMC5336900 DOI: 10.5152/akd.2014.14271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Mariangela Peruzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina-Italy.
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19
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Alıcı H, Balakan O, Ercan S, Çakıcı M, Yavuz F, Davutoğlu V. Evaluation of early subclinical cardiotoxicity of chemotherapy in breast cancer. Anatol J Cardiol 2014; 15:56-60. [PMID: 25179886 PMCID: PMC5336899 DOI: 10.5152/akd.2014.5185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: Cardiac effects of chemotherapy are usually recognized after clinical symptom or sign occurrence in patients with breast cancer. In this study, we aimed to determine the potential subclinical cardiotoxic effects of chemotherapy that were given lower dosage than well known cardiac safety dosage limits in patients with breast cancer during early period. Methods: Fifty-one patients consecutively enrolled to this prospective cohort study. All patients were diagnosed as breast cancer at oncology hospital in University of Gaziantep. Before chemotherapy, all of the patients underwent to detailed ECG and echocardiography (ECHO) examinations. After 6 months, detailed ECG and ECHO examinations were repeated and compared with baseline values. Statistical analysis was performed using Shapiro-Wilk tests, Student t-test and Spearman correlation test. Results: The average age of patients was 51 and one was male. Statistically significant decrease in ejection fraction was found after treatment (62.3%±3.3 and 59.9%±5.9, p=0.002). Evaluation of diastolic parameters; significant increase in the transmitral A flow velocity and significant decrease of E/A ratio were observed on Doppler ECHO analysis (77.4±19.1 cm/sec versus 86±18 cm/sec, p<0.001; 1.01±0.3 versus 0.9±0.2, p=0.03, respectively). On tissue Doppler analysis we observed that significant reduction in the value of E’ and significantly increase E/E’ ratio were present (12.5±3.6 cm/sec versus 10.7±2.9 cm/sec, p=0.001; 6.6±2.9 versus 7.7±3.3, p=0.04, respectively). Conclusion: Chemotherapy has detrimental subclinical effect on both of systolic and diastolic function in early six months period despite the prescription of lower dosage of chemotherapy than well-known cardiac safety dosage limits. Tissue Doppler imaging may be more sensitive than ECG, conventional ECHO and Doppler for determining the subclinical cardiac damage.
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Affiliation(s)
- Hayri Alıcı
- Clinic of Cardiology, 25 Aralık State Hospital, Gaziantep-Turkey.
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20
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Jones LW, Douglas PS, Khouri MG, Mackey JR, Wojdyla D, Kraus WE, Whellan DJ, O'Connor CM. Safety and efficacy of aerobic training in patients with cancer who have heart failure: an analysis of the HF-ACTION randomized trial. J Clin Oncol 2014; 32:2496-502. [PMID: 25002717 DOI: 10.1200/jco.2013.53.5724] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To investigate the efficacy and safety of aerobic training (AT) in patients with cancer with medically stable heart failure (HF). PATIENTS AND METHODS A retrospective analysis of 90 patients with cancer who have HF and who were randomly assigned to AT (n = 47) or guideline-based usual care (UC; n = 43) was performed. AT consisted of three supervised sessions per week at 20 to 45 minutes per session at 60% to 70% of heart rate reserve for 12 weeks followed by home-based sessions for 4 to 12 months. The primary end point was all-cause mortality and hospitalization. Secondary end points were other clinical events, safety, and change in exercise capacity (VO(2peak)) and health-related quality of life (HRQOL). RESULTS Median follow-up was 35 months. In intention-to-treat (ITT) analyses, all-cause mortality or hospitalization at 2 years was 74% in the AT group compared with 67% in the UC group (adjusted hazard ratio [HR], 1.11; 95% CI, 0.69 to 1.77; P = .676). The incidence of cardiovascular mortality or cardiovascular hospitalization was significantly higher in the AT group compared with the UC group (41% v 67%; adjusted HR, 1.94; 95% CI, 1.12 to 3.16; P = .017). There were no differences in any VO(2peak) or HRQOL end points. In post hoc analyses based on adherence to AT, all-cause mortality and hospitalization was 66% in adherent patients (≥ 90 minutes per week) compared with 84% in nonadherent patients (< 90 minutes per week). CONCLUSION In ITT analyses, AT did not improve clinical outcomes in patients with cancer who had HF. Post hoc analyses suggested that patients not capable of adhering to the planned AT prescription may be at increased risk of clinical events.
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Affiliation(s)
- Lee W Jones
- Lee W. Jones, Memorial Sloan Kettering Cancer Center, New York, NY; Pamela S. Douglas, Michel G. Khouri, Daniel Wojdyla, William E. Kraus, and Christopher M. O'Connor, Duke University Medical Center, Durham, NC; John R. Mackey, University of Alberta, Edmonton, Alberta, Canada; and David J. Whellan, Thomas Jefferson University, Philadelphia, PA.
| | - Pamela S Douglas
- Lee W. Jones, Memorial Sloan Kettering Cancer Center, New York, NY; Pamela S. Douglas, Michel G. Khouri, Daniel Wojdyla, William E. Kraus, and Christopher M. O'Connor, Duke University Medical Center, Durham, NC; John R. Mackey, University of Alberta, Edmonton, Alberta, Canada; and David J. Whellan, Thomas Jefferson University, Philadelphia, PA
| | - Michel G Khouri
- Lee W. Jones, Memorial Sloan Kettering Cancer Center, New York, NY; Pamela S. Douglas, Michel G. Khouri, Daniel Wojdyla, William E. Kraus, and Christopher M. O'Connor, Duke University Medical Center, Durham, NC; John R. Mackey, University of Alberta, Edmonton, Alberta, Canada; and David J. Whellan, Thomas Jefferson University, Philadelphia, PA
| | - John R Mackey
- Lee W. Jones, Memorial Sloan Kettering Cancer Center, New York, NY; Pamela S. Douglas, Michel G. Khouri, Daniel Wojdyla, William E. Kraus, and Christopher M. O'Connor, Duke University Medical Center, Durham, NC; John R. Mackey, University of Alberta, Edmonton, Alberta, Canada; and David J. Whellan, Thomas Jefferson University, Philadelphia, PA
| | - Daniel Wojdyla
- Lee W. Jones, Memorial Sloan Kettering Cancer Center, New York, NY; Pamela S. Douglas, Michel G. Khouri, Daniel Wojdyla, William E. Kraus, and Christopher M. O'Connor, Duke University Medical Center, Durham, NC; John R. Mackey, University of Alberta, Edmonton, Alberta, Canada; and David J. Whellan, Thomas Jefferson University, Philadelphia, PA
| | - William E Kraus
- Lee W. Jones, Memorial Sloan Kettering Cancer Center, New York, NY; Pamela S. Douglas, Michel G. Khouri, Daniel Wojdyla, William E. Kraus, and Christopher M. O'Connor, Duke University Medical Center, Durham, NC; John R. Mackey, University of Alberta, Edmonton, Alberta, Canada; and David J. Whellan, Thomas Jefferson University, Philadelphia, PA
| | - David J Whellan
- Lee W. Jones, Memorial Sloan Kettering Cancer Center, New York, NY; Pamela S. Douglas, Michel G. Khouri, Daniel Wojdyla, William E. Kraus, and Christopher M. O'Connor, Duke University Medical Center, Durham, NC; John R. Mackey, University of Alberta, Edmonton, Alberta, Canada; and David J. Whellan, Thomas Jefferson University, Philadelphia, PA
| | - Christopher M O'Connor
- Lee W. Jones, Memorial Sloan Kettering Cancer Center, New York, NY; Pamela S. Douglas, Michel G. Khouri, Daniel Wojdyla, William E. Kraus, and Christopher M. O'Connor, Duke University Medical Center, Durham, NC; John R. Mackey, University of Alberta, Edmonton, Alberta, Canada; and David J. Whellan, Thomas Jefferson University, Philadelphia, PA
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21
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Farmakis D, Parissis J, Filippatos G. Insights into onco-cardiology: atrial fibrillation in cancer. J Am Coll Cardiol 2013; 63:945-53. [PMID: 24361314 DOI: 10.1016/j.jacc.2013.11.026] [Citation(s) in RCA: 252] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 10/30/2013] [Accepted: 11/19/2013] [Indexed: 12/18/2022]
Abstract
Atrial fibrillation (AF) has been found to occur with an increased frequency in patients with malignancies, particularly in those undergoing cancer surgery. The occurrence of AF in cancer may be related to comorbid states or a direct tumor effect or may represent a complication of cancer surgical or medical therapy, whereas inflammation may be a common denominator for both conditions. Treating AF in patients with malignancies is a challenge, especially in terms of antithrombotic therapy, because cancer may result in an increased risk of either thrombosis or hemorrhage and an unpredictable anticoagulation response, whereas thromboembolic risk prediction scores such as CHADS2 (Cardiac Failure, Hypertension, Age, Diabetes, and Stroke [doubled]) may not be applicable. The general lack of evidence imposes an individualized approach to the management of AF in those patients, although some general recommendations based on current guidelines in noncancer patients and the existing evidence in cancer patients, where available, may be outlined.
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Affiliation(s)
- Dimitrios Farmakis
- First Department of Internal Medicine, University of Athens Medical School, Athens, Greece; Second Department of Cardiology, University of Athens Medical School, Athens, Greece
| | - John Parissis
- Second Department of Cardiology, University of Athens Medical School, Athens, Greece
| | - Gerasimos Filippatos
- Second Department of Cardiology, University of Athens Medical School, Athens, Greece.
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22
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Møller T, Lillelund C, Andersen C, Ejlertsen B, Nørgaard L, Christensen KB, Vadstrup E, Diderichsen F, Hendriksen C, Bloomquist K, Adamsen L. At cancer diagnosis: a 'window of opportunity' for behavioural change towards physical activity. A randomised feasibility study in patients with colon and breast cancer. BMJ Open 2013; 3:e003556. [PMID: 24189081 PMCID: PMC3822303 DOI: 10.1136/bmjopen-2013-003556] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Challenges exist in identifying, recruiting and motivating sedentary patients with cancer to initiate physical activity towards recommended levels. We hypothesise that the onset period of adjuvant chemotherapy can be 'the open window of opportunity' to identify and motivate sedentary patients with breast and colon cancers, at risk for developing coronary heart disease, to initiate and sustain lifestyle changes. AIMS To investigate the feasibility of oncologists/nurses screening for physical inactivity, in order to identify and recruit an at-risk population of sedentary patients with breast or colon cancer at the onset of adjuvant chemotherapy. Furthermore, the study will examine the adherence to one of two multimodal exercise interventions lasting 12 weeks; (1) hospital-based, high intensity, group exercise intervention (2) home-based, low intensity, individual, pedometer intervention. Both arms will be compared with a control group. METHODS AND ANALYSES All newly referred patients will be screened for sedentary behaviour, using national recommendations. Testing at baseline, 6, 12 and 39 weeks will include; (1) physiological testing (VO2-peak, one repetition maximum muscle strength and lung function (2) fasting full body dual-energy X-ray absorptiometry scan (3) fasting blood glucose, insulin, lipids and cholesterols, (4) psychometric questionnaires (general well-being, quality of life, anxiety and depression, motivational readiness). The randomised controlled trial feasibility design is selected in order to examine barriers for recruitment, programme adherence, safety aspects and potential efficacy to the interventions during adjuvant chemotherapy. ETHICS AND DISSEMINATION The Scientific Committee of the Capital Region (case No. H-1-2011-131) and the Danish Data Protection Agency (j. No. 2011-41-6349) approved the study. Data will be entered and locked into a database hosted by the Copenhagen Trial Unit, Rigshosptialet. Data will be available for analyses to project members and the trial statistician after the 45 included patients have completed the 12-week test. Results will be published in peer-reviewed scientific journals. TRIAL REGISTRATION Current Controlled Trials ISRCTN24901641.
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Affiliation(s)
- Tom Møller
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Lillelund
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Andersen
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lone Nørgaard
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Karl Bang Christensen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Eva Vadstrup
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Finn Diderichsen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hendriksen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Kira Bloomquist
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Lis Adamsen
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
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Wieshammer S, Dreyhaupt J, Müller D, Momm F, Jakob A, Freund U. Cardiotoxicity and cancer therapy: treatment-related cardiac morbidity in patients presenting with symptoms suggestive of heart or lung disease. Oncology 2013; 85:137-44. [PMID: 23948797 DOI: 10.1159/000354299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 07/08/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Cardiac injury is one of the complications of cancer treatment. This study aimed to investigate the relationships between the types of radiotherapy of the chest (RT), chemotherapy (CT), cancer surgery (CS) and endocrine therapy (ET), and the presence of heart disease, and their associations with the serum level of N-terminal pro-B-type natriuretic peptide (NT-proBNP). METHODS A consecutive series of 374 patients with cancer who were referred because of symptoms suggestive of heart or lung disease prospectively underwent a diagnostic workup. RESULTS The prevalence of heart disease was 36.9%. RT administered before 1995 (n = 19) was associated with both increased odds of heart disease [adjusted odds ratio 10.3, 95% confidence interval 3.1-34.0] and higher ln-transformed NT-proBNP values (p < 0.01) compared to the control group (no RT or RT for right-sided breast cancer from 1995 onwards; n = 311). Anthracycline-treated patients (n = 54) had higher adjusted values for ln(NT-proBNP) compared to the control group (no CT; n = 243; p < 0.01) but no increased odds of heart disease. CONCLUSIONS While pre-1995 RT and anthracycline-containing CT were associated with cardiac effects, there was no evidence that RT using modern cardioprotective techniques, CT in the absence of anthracyclines, CS or ET had detrimental effects on the heart.
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Affiliation(s)
- Siegfried Wieshammer
- Department of Cardiology, Pulmonology and Critical Care Medicine, Offenburg Hospital, Offenburg, Germany
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Weaver KE, Foraker RE, Alfano CM, Rowland JH, Arora NK, Bellizzi KM, Hamilton AS, Oakley-Girvan I, Keel G, Aziz NM. Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care? J Cancer Surviv 2013; 7:253-61. [PMID: 23417882 PMCID: PMC3756807 DOI: 10.1007/s11764-013-0267-9] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/23/2013] [Indexed: 01/15/2023]
Abstract
PURPOSE Individuals diagnosed with high survival cancers will often die of cardiovascular disease (CVD) rather than a recurrence of their cancer, yet CVD risk factors may be overlooked during survivorship care. We assess the prevalence of CVD risk factors among long-term cancer survivors and compare results to survey data from the general population in the same geographic region. We also characterize how often at-risk survivors discuss CVD-related health behaviors with their health care providers. METHODS Survivors (n = 1,582) of breast, prostate, colorectal, and gynecologic cancers, 4-14 years after diagnosis, were recruited from two California cancer registries for a cross-sectional mail survey. We assessed CVD risk factors, including smoking, body mass index, physical inactivity, hypercholesterolemia, hypertension, and diabetes, as well as report of discussions with health care providers about diet, exercise, smoking, and lifestyle change assistance. RESULTS With the exception of current smoking, CVD risk factors were more common among survivors than the general adult population. Of survivors, 62.0 % were overweight or obese, 55.0 % reported hypertension, 20.7 % reported diabetes, 18.1 % were inactive, and 5.1 % were current smokers. Compared to white, non-Hispanic survivors, Hispanic (b = 0.37, p = 0.007) and African-American (b = 0.66, p < 0.0001), but not Asian, survivors reported significantly more risk factors. One in three survivors with one or more risk factors for CVD did not report a health promotion discussion with their health care providers. CONCLUSIONS CVD risk factors are common among long-term survivors, but many at-risk survivors may not discuss lifestyle prevention with their health care team. Primary care and oncology should work together to deliver optimal survivorship care that addresses CVD risk factors, as well as prevalent disease. IMPLICATIONS FOR CANCER SURVIVORS Cardiovascular disease may compromise cancer survivors' long-term health and well-being, yet cardiovascular risk factors may be overlooked during survivorship care. We document that CVD risk factors are common among cancers survivors, yet nearly a third of survivors do not report health promotion discussions with their medical teams. Survivors should be aware of their cardiovascular risk factors and initiate discussions with their medical teams about health promotion topics, if appropriate.
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Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Evaluation of Maximal Heart Rate Prediction Equations for Women During Breast Cancer Treatment: A Measurement Focused Study. REHABILITATION ONCOLOGY 2013. [DOI: 10.1097/01893697-201331020-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hu YF, Liu CJ, Chang PMH, Tsao HM, Lin YJ, Chang SL, Lo LW, Tuan TC, Li CH, Chao TF, Chung FP, Liao JN, Chen TJ, Chen SA. Incident thromboembolism and heart failure associated with new-onset atrial fibrillation in cancer patients. Int J Cardiol 2012; 165:355-7. [PMID: 22989607 DOI: 10.1016/j.ijcard.2012.08.036] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/23/2012] [Indexed: 11/25/2022]
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Plana JC. La quimioterapia y el corazón. Rev Esp Cardiol 2011; 64:409-15. [DOI: 10.1016/j.recesp.2010.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
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