1
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Xue J, Ye B, Sun M. Possible pathogenic mechanisms for doxorubicin-induced splenic atrophy in a human breast cancer xenograft mouse model. J Appl Toxicol 2024. [PMID: 38943348 DOI: 10.1002/jat.4666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 07/01/2024]
Abstract
Doxorubicin-based chemotherapy is a widely used first-line treatment for breast cancer, yet it is associated with various side effects, including splenic atrophy. However, the pathogenic mechanisms underlying doxorubicin-induced atrophy of the spleen remain unclear. This study investigates that doxorubicin treatment leads to splenic atrophy through several interconnected pathways involving histological changes, an inflammatory response, and apoptosis. Immunohistochemical and western blot analyses revealed reduced size of white and red pulp, decreased cellularity, amyloidosis, and fibrotic remodeling in the spleen following doxorubicin treatment. Additionally, increased secretion of pro-inflammatory cytokines was detected using an antibody array and enzyme-linked immunosorbent assay (ELISA), which triggers inflammation through the regulation of signal transducer and activator of transcription 3 (STAT3) and nuclear factor-kappa B (NF-κB) signaling pathways. Further analysis revealed that the loss of regulators and effectors of the oxidative defense system, including sirtuin (Sirt)3, Sirt5, superoxide dismutase (SOD)1, and SOD2, was implicated in the upstream regulation of caspase-dependent cellular apoptosis. These findings provide insights on the pathogenic mechanisms underlying doxorubicin-induced splenic atrophy and suggest that further investigation may be warranted to explore strategies for managing potential side effects in breast cancer patients treated with doxorubicin.
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Affiliation(s)
- Jianjie Xue
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
- Qingdao Institute of Preventive Medicine, Qingdao, China
| | - Bing Ye
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
- Qingdao Institute of Preventive Medicine, Qingdao, China
| | - Mengqi Sun
- College of Life Science, Changchun Sci-Tech University, Changchun, China
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2
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Oh HS, Kim TH, Kim JW, Yang J, Lee HS, Lee JH, Park CH. Feasibility and limitations of deep learning-based coronary calcium scoring in PET-CT: a comparison with coronary calcium score CT. Eur Radiol 2024; 34:4077-4088. [PMID: 37962596 DOI: 10.1007/s00330-023-10390-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE This study aimed to determine the feasibility and limitations of deep learning-based coronary calcium scoring using positron emission tomography-computed tomography (PET-CT) in comparison with coronary calcium scoring using ECG-gated non-contrast-enhanced cardiac computed tomography (CaCT). MATERIALS AND METHODS A total of 215 individuals who underwent both CaCT and PET-CT were enrolled in this retrospective study. The Agatston method was used to calculate the coronary artery calcium scores (CACS) from CaCT, PET-CT(reader), and PET-CT(AI) to analyse the effect of using different modalities and AI-based software on CACS measurement. The total CACS and CACS classified according to the CAC-DRS guidelines were compared between the three sets of CACS. The differences, correlation coefficients, intraclass coefficients (ICC), and concordance rates were analysed. Statistical significance was set at p < 0.05. RESULTS The correlation coefficient of the total CACS from CaCT and PET-CT(reader) was 0.837, PET-CT(reader) and PET-CT(AI) was 0.894, and CaCT and PET-CT(AI) was 0.768. The ICC of CACS from CaCT and PET-CT(reader) was 0.911, PET-CT(reader) and PET-CT(AI) was 0.958, and CaCT and PET-CT(AI) was 0.842. The concordance rate between CaCT and PET-CT(AI) was 73.8%, with a false-negative rate of 37.3% and a false-positive rate of 4.4%. Age and male sex were associated with an increased misclassification rate. CONCLUSIONS Artificial intelligence-assisted CACS measurements in PET-CT showed comparable results to CACS in coronary calcium CT. However, the relatively high false-negative results and tendency to underestimate should be of concern. CLINICAL RELEVANCE STATEMENT Application of automated calcium scoring to PET-CT studies could potentially select patients at high risk of coronary artery disease from among cancer patients known to be susceptible to coronary artery disease and undergoing routine PET-CT scans. KEY POINTS • Cancer patients are susceptible to coronary disease, and PET-CT could be potentially used to calculate coronary artery calcium score (CACS). • Calcium scoring using artificial intelligence in PET-CT automatically provides CACS with high ICC to CACS in coronary calcium CT. • However, underestimation and false negatives of CACS calculation in PET-CT should be considered.
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Affiliation(s)
- Hee Sang Oh
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, Republic of Korea
| | - Tae Hoon Kim
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, Republic of Korea
| | - Ji Won Kim
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, Republic of Korea
| | - Juyeon Yang
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hoon Lee
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, Republic of Korea.
| | - Chul Hwan Park
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, Republic of Korea.
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3
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Knowles R, Kemp E, Miller M, Koczwara B. Reducing the impact of cardiovascular disease in older people with cancer: a qualitative study of healthcare providers. J Cancer Surviv 2024; 18:818-827. [PMID: 36648743 PMCID: PMC11081978 DOI: 10.1007/s11764-023-01331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE Cancer survivors are at greater risk of cardiovascular disease (CVD) than cancer-free controls. Despite evidence-based guidelines recommending CVD risk factor assessment, surveillance and risk-reduction, many people with cancer do not receive adequate CVD care. To address potential barriers and enablers of care, we examined healthcare professionals' (HCPs) perceptions and experiences of CVD risk assessment and management in people with cancer. METHODS We conducted one focus group and 12 individual interviews to examine HCPs' perceptions and experiences of CVD care in care. We used reflexive thematic analysis to collect and analyse the qualitative data to construct and understand themes. RESULTS Twenty-one HCPs participated (8 oncologists, 5 nurses, 3 general practitioners, 2 dietitians, 1 cardiologist, 1 haematologist and 1 physiotherapist). Majority of HCPs were aware of CVD risk in cancer but were concerned they could not deliver CVD care alone due to system-level barriers including lack of time and training. HCPs also perceived patient-level barriers including socioeconomic disadvantage and fatalistic outlook. Despite barriers, HCPs suggested diverse solutions for improving CVD care in cancer including new models-of-care, clinical pathways, risk assessment/management tools and education. CONCLUSIONS The diversity of perceived barriers and suggested solutions identified by HCPs suggests the need for a multilevel approach tailored to context. Future research involving people with cancer is needed to co-design acceptable interventions. IMPLICATIONS FOR CANCER SURVIVORS Improved understanding of HCP's perceptions can inform the development of new interventions to deliver CVD care to people with cancer to reduce morbidity and mortality.
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Affiliation(s)
- Reegan Knowles
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
| | - Emma Kemp
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Michelle Miller
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Bogda Koczwara
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
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4
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Logotheti S, Pavlopoulou A, Rudsari HK, Galow AM, Kafali Y, Kyrodimos E, Giotakis AI, Marquardt S, Velalopoulou A, Verginadis II, Koumenis C, Stiewe T, Zoidakis J, Balasingham I, David R, Georgakilas AG. Intercellular pathways of cancer treatment-related cardiotoxicity and their therapeutic implications: The paradigm of radiotherapy. Pharmacol Ther 2024:108670. [PMID: 38823489 DOI: 10.1016/j.pharmthera.2024.108670] [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: 11/11/2023] [Revised: 05/16/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
Advances in cancer therapeutics have improved patient survival rates. However, cancer survivors may suffer from adverse events either at the time of therapy or later in life. Cardiovascular diseases (CVD) represent a clinically important, but mechanistically understudied complication, which interfere with the continuation of best-possible care, induce life-threatening risks, and/or lead to long-term morbidity. These concerns are exacerbated by the fact that targeted therapies and immunotherapies are frequently combined with radiotherapy, which induces durable inflammatory and immunogenic responses, thereby providing a fertile ground for the development of cardiovascular diseases (CVDs). Stressed and dying irradiated cells produce 'danger' signals including, but not limited to, major histocompatibility complexes, cell-adhesion molecules, proinflammatory cytokines, and damage-associated molecular patterns. These factors activate intercellular signaling pathways which have potentially detrimental effects on the heart tissue homeostasis. Herein, we present the clinical crosstalk between cancer and heart diseases, describe how it is potentiated by cancer therapies, and highlight the multifactorial nature of the underlying mechanisms. We particularly focus on radiotherapy, as a case known to often induce cardiovascular complications even decades after treatment. We provide evidence that the secretome of irradiated tumors entails factors that exert systemic, remote effects on the cardiac tissue, potentially predisposing it to CVDs. We suggest how diverse disciplines can utilize pertinent state-of-the-art methods in feasible experimental workflows, to shed light on the molecular mechanisms of radiotherapy-related cardiotoxicity at the organismal level and untangle the desirable immunogenic properties of cancer therapies from their detrimental effects on heart tissue. Results of such highly collaborative efforts hold promise to be translated to next-generation regimens that maximize tumor control, minimize cardiovascular complications, and support quality of life in cancer survivors.
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Affiliation(s)
- Stella Logotheti
- DNA Damage Laboratory, Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou, 15780, Athens, Greece.
| | - Athanasia Pavlopoulou
- Izmir Biomedicine and Genome Center, Izmir, Turkey; Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
| | | | - Anne-Marie Galow
- Institute for Genome Biology, Research Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany
| | - Yağmur Kafali
- Izmir Biomedicine and Genome Center, Izmir, Turkey; Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
| | - Efthymios Kyrodimos
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Aris I Giotakis
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Stephan Marquardt
- Institute of Translational Medicine for Health Care Systems, Medical School Berlin, Hochschule Für Gesundheit Und Medizin, 14197 Berlin, Germany
| | - Anastasia Velalopoulou
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ioannis I Verginadis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Constantinos Koumenis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thorsten Stiewe
- Institute of Molecular Oncology, Philipps-University, 35043 Marburg, Germany; German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center (UGMLC), 35043 Marburg, Germany; Genomics Core Facility, Philipps-University, 35043 Marburg, Germany; Institute for Lung Health (ILH), Justus Liebig University, 35392 Giessen, Germany
| | - Jerome Zoidakis
- Department of Biotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece; Department of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert David
- Department of Cardiac Surgery, Rostock University Medical Center, 18057 Rostock, Germany; Department of Life, Light & Matter, Interdisciplinary Faculty, Rostock University, 18059 Rostock, Germany
| | - Alexandros G Georgakilas
- DNA Damage Laboratory, Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou, 15780, Athens, Greece.
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5
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Pinjari D, Patil Y, Misra R. Near-Infrared Absorbing Aza-BODIPY Dyes for Optoelectronic Applications. Chem Asian J 2024:e202400167. [PMID: 38733151 DOI: 10.1002/asia.202400167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
Organic dyes that absorb light in the visible to near-infrared region have garnered significant interest, owing to their extensive utility in organic photovoltaics and various biomedical applications. Aza-boron-dipyrromethene (Aza-BODIPY) dyes are a class of chromophores with impressive photophysical properties such as tunable absorption from the visible region towards near infrared (NIR) region, high molar absorptivity, and fluorescence quantum yield. In this review, we discuss the developments in the aza-BODIPYs, related to their synthetic routes, photophysical properties and their applications. Their design strategies, modifications in chemical structures, mode/position of attachment, and their impact on photo-physical properties are reviewed. The potential applications of aza-BODIPY derivatives such as organic solar cells, photodynamic therapy, boron-neutron capture therapy, fluorescence sensors, photo-redox catalysis, photoacoustic probes and optoelectronic devices are explained.
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Affiliation(s)
- Dilip Pinjari
- Department of Chemistry, Indian Institute of Technology Indore, Indore, 453552, India
| | - Yuvraj Patil
- Department of Chemistry and Biochemistry, North Dakota State University, Fargo, North Dakota, 58108, United States
| | - Rajneesh Misra
- Department of Chemistry, Indian Institute of Technology Indore, Indore, 453552, India
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6
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Cao L, Wang X, Li X, Ma L, Li Y. Identification of Co-diagnostic Genes for Heart Failure and Hepatocellular Carcinoma Through WGCNA and Machine Learning Algorithms. Mol Biotechnol 2024; 66:1229-1245. [PMID: 38236461 DOI: 10.1007/s12033-023-01025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024]
Abstract
This research delves into the intricate relationship between hepatocellular carcinoma (HCC) and heart failure (HF) by exploring shared genetic characteristics and molecular processes. Employing advanced methodologies such as differential analysis, weighted correlation network analysis (WGCNA), and algorithms like Random Forest (RF), Least Absolute Shrinkage Selection (LASSO), and XGBoost, we meticulously identified modular differential genes (DEGs) associated with both HF and HCC. Gene Set Variation Analysis (GSVA) and single sample gene set enrichment analysis (ssGSEA) were employed to unveil underlying biological mechanisms. The study revealed 88 core genes shared between HF and HCC, indicating a common mechanism. Enrichment analysis emphasized the roles of immune responses and inflammation in both diseases. Leveraging XGBoost, we crafted a robust multigene diagnostic model (including FCN3, MAP2K1, AP3M2, CDH19) with an area under the curve (AUC) > 0.9, showcasing exceptional predictive accuracy. GSVA and ssGSEA analyses unveiled the involvement of immune cells and metabolic pathways in the pathogenesis of HF and HCC. This research uncovers a pivotal interplay between HF and HCC, highlighting shared pathways and key genes, offering promising insights for future clinical treatments and experimental research endeavors.
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Affiliation(s)
- Lizhi Cao
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Xiaoying Wang
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, China
| | - Xin Li
- Physical Examination Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Linlin Ma
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, China.
- University of Shanghai for Science and Technology, Shanghai, 200093, China.
| | - Yanfei Li
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, China.
- University of Shanghai for Science and Technology, Shanghai, 200093, China.
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7
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Rivera Boadla ME, Sharma NR, Khan MH, Khurana S, Gulati A, Tan S, Sharma A, Hooda A, K C P. Cancer as an Individual Risk Factor for Heart Failure: A Review of Literature. Cureus 2024; 16:e60592. [PMID: 38894762 PMCID: PMC11185020 DOI: 10.7759/cureus.60592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
The intricate relationship between cancer and cardiovascular diseases (CVD), notably heart failure (HF), is gaining attention in the medical field. This literature review explores the intricate interplay between cancer and CVD, particularly HF, emphasizing their significant impact on global mortality and comorbidity. While preventive measures have contributed to reducing their incidence, challenges persist in predicting and managing cancer-related complications. This review article delves into various risk factors associated with both cancer and HF, including lifestyle factors, genetic predispositions, and immune system dysregulation. It highlights emerging evidence suggesting a direct interaction between cancer and HF, with studies indicating an elevated risk of mortality from cancer in patients with HF and vice versa. Pathological mechanisms such as inflammation, oxidative stress, and tissue hypoxia are implicated in cancer-induced cardiac dysfunction, underscoring the need for comprehensive clinical investigations and ethical considerations in patient care. The review also discusses the potential role of biomarkers in risk assessment, early detection of cardiotoxicity, and understanding common pathophysiological links between cancer and HF, paving the way for multifaceted preventive and therapeutic approaches.
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Affiliation(s)
| | - Nava R Sharma
- Internal Medicine, Maimonides Medical Center, New York, USA
- Medicine, Manipal College of Medical Science, Pokhara, NPL
| | | | - Sakshi Khurana
- Radiology, New York Presbyterian-Columbia University Irving Medical Center, New York, USA
| | - Amit Gulati
- Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Samuel Tan
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Anupam Sharma
- Hematology and Oncology, Fortis Hospital, Noida, Noida, IND
| | - Amit Hooda
- Interventional Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Prabal K C
- Internal Medicine, Rasuwa District Hospital, Kathmandu, NPL
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8
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Beito MR, Ashraf S, Odogwu D, Harmancey R. Role of Ectopic Olfactory Receptors in the Regulation of the Cardiovascular-Kidney-Metabolic Axis. Life (Basel) 2024; 14:548. [PMID: 38792570 PMCID: PMC11122380 DOI: 10.3390/life14050548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Olfactory receptors (ORs) represent one of the largest yet least investigated families of G protein-coupled receptors in mammals. While initially believed to be functionally restricted to the detection and integration of odors at the olfactory epithelium, accumulating evidence points to a critical role for ectopically expressed ORs in the regulation of cellular homeostasis in extranasal tissues. This review aims to summarize the current state of knowledge on the expression and physiological functions of ectopic ORs in the cardiovascular system, kidneys, and primary metabolic organs and emphasizes how altered ectopic OR signaling in those tissues may impact cardiovascular-kidney-metabolic health.
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Affiliation(s)
| | | | | | - Romain Harmancey
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.R.B.); (S.A.); (D.O.)
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9
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Chan JSK, Chan RNC, Lee YHA, Satti DI, Dee EC, Ng K, Achim A, Ng CF, Liu T, Matthews GDK, Tse G, Vassiliou VS. Cardiovascular health of patients with cancer: Challenges abound. Trends Cardiovasc Med 2024:S1050-1738(24)00036-7. [PMID: 38657744 DOI: 10.1016/j.tcm.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
Patients with cancer have elevated cardiovascular risks compared to those without cancer. As cancer incidence increases and cancer-related mortality decreases, cardiovascular diseases in patients with a history of cancer will become increasingly important. This in turn is reflected by the exponentially increasing amount of cardio-oncology research in recent years. This narrative review aims to summarize the key existing literature in several main areas of cardio-oncology, including the epidemiology, natural history, prevention, management, and determinants of the cardiovascular health of patients with cancer, and identify relevant gaps in evidence for further research.
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Affiliation(s)
- Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China
| | - Raymond Ngai Chiu Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China
| | - Yan Hiu Athena Lee
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China; Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China; SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Danish Iltaf Satti
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, PR China; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kenrick Ng
- Department of Medical Oncology, Barts Cancer Centre, London, UK
| | - Alexandru Achim
- Department of Internal Medicine, Invasive Cardiology Division, University of Szeged, Szeged, Hungary; Department of Cardiology, "Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Chi Fai Ng
- Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China; SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - Gareth D K Matthews
- Norwich Medical School, University of East Anglia, Norwich Research Park, Rosalind Franklin Road, Norwich, UK; Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Colney Lane, Norwich, UK
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China; Kent and Medway Medical School, Canterbury, Kent CT2 7NT, UK; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, PR China.
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Norwich Research Park, Rosalind Franklin Road, Norwich, UK; Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Colney Lane, Norwich, UK
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10
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Shen R, Zou T. Association Between Cancer and Cardiovascular Toxicity: A Nationwide Cross-Sectional Study on NHANES 1999-2018. Cardiovasc Toxicol 2024; 24:351-364. [PMID: 38466544 DOI: 10.1007/s12012-024-09845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
There is a dearth of evidence pertaining to the relationship of cardiovascular disease (CVD) and its subtype with adjudicated cancer, thereby limiting our understanding of the heightened risk of CVD resulting from long-term complications of cancer and its therapies. The aim of this study was to quantify the risks of CVD and its subtypes in adult cancer survivors compared with cancer-free controls in a nationwide cross-sectional study on Continuous National Health and Nutrition Examination Survey (NHANES). We included 44,442 participants ranging in age from 20 to 85 years. Cancer and CVD diagnoses were ascertained via the household questionnaires. The association of cancer status with the risk of CVD and CVD subtype was examined using weighted logistic regression. Stratification analyses were also performed by age, sex, race, marital status, income status, educational level, and hyperlipidemia. The Wald test was used to calculate P-value for interaction. A total of 4178 participants have cancer, while 4829 participants had CVD, respectively. In the multivariable-adjusted model, the cancer was consistently linked to an elevated risk of CVD. Stratification analyses showed that stronger association between cancer status and CVD risk was found in younger adults, non-white, and participants living without a spouse or partner, and without hyperlipidemia. Our study confirmed that cancer participants were strongly linked to living with CVD, independent of traditional cardiovascular risk factors, especially in younger adults, non-white, and participants living without a spouse or partner, and without hyperlipidemia. There exists a pressing requirement to establish effective strategies for the prevention of CVD within this population characterized by a heightened risk.
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Affiliation(s)
- Ruihuan Shen
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Tong Zou
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
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11
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Guan T, Monteiro O, Chen D, Luo Z, Chi K, Li Z, Liang Y, Lu Z, Jiang Y, Yang J, Lin W, Yi M, Zhang K, Ou C. Long-term and short-term cardiovascular disease mortality among patients of 21 non-metastatic cancers. J Adv Res 2024:S2090-1232(24)00117-6. [PMID: 38537701 DOI: 10.1016/j.jare.2024.03.017] [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: 01/21/2024] [Revised: 03/05/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Previous studies on cardiovascular disease (CVD) death risk in cancer patients mostly focused on overall cancer, age subgroups and single cancers. OBJECTIVES To assess the CVD death risk in non-metastatic cancer patients at 21 cancer sites. METHODS A total of 1,672,561 non-metastatic cancer patients from Surveillance, Epidemiology, and End Results (SEER) datebase (1975-2018) were included in this population-based study, with a median follow-up of 12·7 years. The risk of CVD deaths was assessed using proportions, competing-risk regression, absolute excess risks (AERs), and standardized mortality ratios (SMRs). RESULTS In patients with localized cancers, the proportion of CVD death and cumulative mortality from CVD in the high-competing risk group (14 of 21 unique cancers) surpassed that of primary neoplasm after cancer diagnosis. The SMRs and AERs of CVD were found higher in patients with non-metastatic cancer than the general US population (SMR 1·96 [95 %CI, 1·95-1·97]-19·85[95 %CI, 16·69-23·44]; AER 5·77-210·48), heart disease (SMR 1·94[95 %CI, 1·93-1·95]-19·25[95 %CI, 15·76-23·29]; AER 4·36-159·10) and cerebrovascular disease (SMR 2·05[95 %CI, 2·02-2·08]-24·71[95 %CI, 16·28-35·96]; AER 1·01-37·44) deaths. In the high-competing risk group, CVD-related SMR in patients with localized stage cancer increased with survival time but followed a reverse-dipper pattern in the low-competing risk group (7 of 21 cancers). The high-competing risk group had higher CVD-related death risks than the low-competing risk group. CONCLUSION The CVD death risk in patients with non-metastatic cancer varied by cancer stage, site and survival time. The risk of CVD mortality is higher in 14 out of 21 localized cancers (high-competing cancers). Targeted strategies for CVD management in non-metastatic cancer patients are needed.
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Affiliation(s)
- Tianwang Guan
- Cancer Center, The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China; Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou 510515, China
| | - Olivia Monteiro
- Faculty of Medicine, Medical Sciences Division, Macau University of Science and Technology, Avenida da Harmonia, Praia Park, Coloane, Macao 999078, China
| | - Dongting Chen
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Zehao Luo
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Kaiyi Chi
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China; Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Zhihao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Yinglan Liang
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Zhenxing Lu
- The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China
| | - Yanting Jiang
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Jinming Yang
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Wenrui Lin
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Min Yi
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510180, China
| | - Kang Zhang
- Faculty of Medicine, Medical Sciences Division, Macau University of Science and Technology, Avenida da Harmonia, Praia Park, Coloane, Macao 999078, China; The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China.
| | - Caiwen Ou
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou 510515, China; The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China.
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Jimenez J, Amrute J, Ma P, Wang X, Dai R, Lavine KJ. CD40 is an immune checkpoint regulator that potentiates myocardial inflammation through activation and expansion of CCR2 + macrophages and CD8 T-cells. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.14.584418. [PMID: 38559055 PMCID: PMC10980053 DOI: 10.1101/2024.03.14.584418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Novel immune checkpoint therapeutics including CD40 agonists have tremendous promise to elicit antitumor responses in patients resistant to current therapies. Conventional immune checkpoint inhibitors (PD-1/PD-L1, CTLA-4 antagonists) are associated with serious adverse cardiac events including life-threatening myocarditis. However, little is known regarding the potential for CD40 agonists to trigger myocardial inflammation or myocarditis. Here, we leveraged genetic mouse models, single cell sequencing, and cell depletion studies to demonstrate that an anti-CD40 agonist antibody reshapes the cardiac immune landscape through activation of CCR2 + macrophages and subsequent recruitment of effector memory CD8 T-cells. We identify a positive feedback loop between CCR2 + macrophages and CD8 T-cells driven by IL12b, TNF, and IFN-γ signaling that promotes myocardial inflammation and show that prior exposure to CD40 agonists sensitizes the heart to secondary insults and accelerates LV remodeling. Collectively, these findings highlight the potential for CD40 agonists to promote myocardial inflammation and potentiate heart failure pathogenesis.
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13
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Vakilpour A, Lefebvre B, Lai C, Scherrer-Crosbie M. Heartbreaker: Detection and prevention of cardiotoxicity in hematological malignancies. Blood Rev 2024; 64:101166. [PMID: 38182490 DOI: 10.1016/j.blre.2023.101166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024]
Abstract
Cancer survivors are at significant risk of cardiovascular (CV) morbidity and mortality; patients with hematologic malignancies have a higher rate of death due to heart failure compared to all other cancer subtypes. The majority of conventional hematologic cancer treatments is associated with increased risk of acute and long-term CV toxicity. The incidence of cancer therapy induced CV toxicity depends on the combination of patient characteristics and on the type, dose, and duration of the therapy. Early diagnosis of CV toxicity, appropriate referral, more specific cardiac monitoring follow-up and timely interventions in target patients can decrease the risk of CV adverse events, the interruption of oncological therapy, and improve the patient's prognosis. Herein, we summarize the CV effects of conventional treatments used in hematologic malignancies with a focus on definitions and incidence of the most common CV toxicities, guideline recommended early detection approaches, and preventive strategies before and during cancer treatments.
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Affiliation(s)
- Azin Vakilpour
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Bénédicte Lefebvre
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; The Thalheimer Center for Cardio-oncology, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Catherine Lai
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Marielle Scherrer-Crosbie
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; The Thalheimer Center for Cardio-oncology, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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14
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Talty A, Morris R, Deighan C. Home-based self-management multimodal cancer interventions & cardiotoxicity: a scoping review. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:12. [PMID: 38424647 PMCID: PMC10903028 DOI: 10.1186/s40959-024-00204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Due to advancements in methods of cancer treatment, the population of people living with and beyond cancer is dramatically growing. The number of cancer survivors developing cardiovascular diseases and heart failure is also rising, due in part to the cardiotoxic nature of many cancer treatments. Guidelines are being increasingly released, emphasising the need for interdisciplinary action to address this gap in survivorship care. However, the extent to which interventions exist, incorporating the recommendations of cardio-oncology research, remains undetermined. OBJECTIVE The aim of this scoping review is to assess the nature, extent and remit of existing cancer care interventions and their integration of cardio-oncology principles. METHODS The review was conducted in accordance with the PRISMA Extension for Scoping Reviews Guidelines. Databases were independently searched for articles from 2010 to 2022, by two members of the research team. Data were charted and synthesised using the following criteria: (a) the focus of the intervention (b) the medium of delivery (c) the duration (d) the modalities included in the interventions (e) the research articles associated with each intervention (f) the type of studies conducted (g) key measures used (h) outcomes reported. RESULTS Interventions encompassed six key modalities: Psychological Support, Physical Activity, Nutrition, Patient Education, Lifestyle and Caregiver Support. The focus, medium of delivery and duration of interventions varied significantly. While a considerable number of study protocols and pilot studies exist documenting HSMIs, only 25% appear to have progressed beyond this stage of development. Of those that have, the present review did not identify any 'feasible' interventions that covered each of the six modalities, while being generalisable to all cancer survivors and incorporating the recommendations from cardio-oncology research. CONCLUSION Despite the substantial volume of research and evidence from the field of cardio-oncology, the findings of this scoping review suggest that the recommendations from guidelines have yet to be successfully translated from theory to practice. There is an opportunity, if not necessity, for cardiac rehabilitation to expand to meet the needs of those living with and beyond cancer.
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Affiliation(s)
- Anna Talty
- The Heart Manual Department, Astley Ainslie Hospital, Grange Loan, Edinburgh, Scotland, UK, EH9 2HL
| | - Roseanne Morris
- The Heart Manual Department, Astley Ainslie Hospital, Grange Loan, Edinburgh, Scotland, UK, EH9 2HL
| | - Carolyn Deighan
- The Heart Manual Department, Astley Ainslie Hospital, Grange Loan, Edinburgh, Scotland, UK, EH9 2HL.
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15
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Mani K, Deng D, Lin C, Wang M, Hsu ML, Zaorsky NG. Causes of death among people living with metastatic cancer. Nat Commun 2024; 15:1519. [PMID: 38374318 PMCID: PMC10876661 DOI: 10.1038/s41467-024-45307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024] Open
Abstract
Studying survivorship and causes of death in patients with advanced or metastatic cancer remains an important task. We characterize the causes of death among patients with metastatic cancer, across 13 cancer types and 25 non-cancer causes and predict the risk of death after diagnosis from the diagnosed cancer versus other causes (e.g., stroke, heart disease, etc.). Among 1,030,937 US (1992-2019) metastatic cancer survivors, 82.6% of patients (n = 688,529) died due to the diagnosed cancer, while 17.4% (n = 145,006) died of competing causes. Patients with lung, pancreas, esophagus, and stomach tumors are the most likely to die of their metastatic cancer, while those with prostate and breast cancer have the lowest likelihood. The median survival time among patients living with metastases is 10 months; our Fine and Gray competing risk model predicts 1 year survival with area under the receiver operating characteristic curve of 0.754 (95% CI [0.754, 0.754]). Leading non-cancer deaths are heart disease (32.4%), chronic obstructive and pulmonary disease (7.9%), cerebrovascular disease (6.1%), and infection (4.1%).
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Affiliation(s)
- Kyle Mani
- Albert Einstein School of Medicine, Bronx, NY, USA
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Daxuan Deng
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Christine Lin
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Melinda L Hsu
- Division of Hematology and Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Ou W, Jiang T, Zhang N, Lu K, Weng Y, Zhou X, Wang D, Dong Q, Tang X. Role of HDL cholesterol in anthracycline-induced subclinical cardiotoxicity: a prospective observational study in patients with diffuse large B-cell lymphoma treated with R-CHOP. BMJ Open 2024; 14:e074541. [PMID: 38341200 PMCID: PMC10862278 DOI: 10.1136/bmjopen-2023-074541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES Anthracycline-induced cardiotoxicity is a debilitating cardiac dysfunction for which there are no effective treatments, making early prevention of anthracycline-induced subclinical cardiotoxicity (AISC) crucial. High-density lipoprotein cholesterol (HDL-C) plays a role in cardioprotection, but its impact on AISC remains unclear. Our study aims to elucidate the protective capacity of HDL-C in AISC in patients with diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP (cyclophosphamide, vincristine, doxorubicin, prednisone and rituximab). DESIGN Prospective observational study. SETTING Conducted in China from September 2020 to September 2022. PARTICIPANTS 70 chemotherapy-naïve patients newly diagnosed with DLBCL who were scheduled to receive the standard dose of R-CHOP; 60 participants included in a case-control study (DOI: 10.1186/s12885-022-10085-6). PRIMARY OUTCOME MEASURES Serum biomarkers, 2D speckle tracking echocardiography and conventional echocardiography were measured at baseline, at the end of the third and sixth cycles of R-CHOP and 6 and 12 months after chemotherapy. RESULTS 24 patients experienced AISC, while 10 did not. 36 patients were lost to follow-up and death. Cox regression analysis showed that higher levels of HDL-C were associated with a significantly lower risk of AISC (unadjusted HR=0.24, 95% CI 0.09 to 0.67, p=0.006; adjusted HR=0.27, 95% CI 0.09 to 0.79, p=0.017). Patients without AISC had a more stable and higher HDL-C level during the follow-up period. HDL-C levels significantly decreased from the end of the third cycle of chemotherapy to the end of the sixth cycle of chemotherapy in all patients (p=0.034), and particularly in the AISC group (p=0.003). The highest level of HDL-C was significantly higher in patients without AISC than in those with AISC (1.52±0.49 vs 1.22±0.29, p=0.034). CONCLUSIONS Our study suggests that higher HDL-C levels may associate with lower AISC risk in patients with DLBCL treated with R-CHOP. HDL-C could be a cardioprotective target, but further research is needed to confirm its benefits and limitations. STUDY REGISTRATION NUMBER Study registration number: ChiCTR2100054721.
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Affiliation(s)
- Wenxin Ou
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tiantian Jiang
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nan Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Lu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Weng
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Zhou
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Wang
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Dong
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoqiong Tang
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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17
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He D, Qin K, Li J, Li Y, Chen Z, Xu J, Zhu Y. Increased incidence risks of cardiovascular disease among cancer patients: Evidence from a population-based cohort study in China. Int J Cardiol 2024; 396:131362. [PMID: 37722455 DOI: 10.1016/j.ijcard.2023.131362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/20/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is becoming a major concern among cancer patients, leading to the development of a new field named cardio-oncology. However, previous studies were mainly based on the western population and focused on CVD mortality. Evidence from the Chinese population is limited. Furthermore, few studies investigated the incidence risks of CVD among cancer patients. METHODS 85,787 eligible cancer patients were included from Hangzhou city, China. Age-standardized standard incidence ratio (SIR) was used to reflect the incidence risks of CVD among cancer patients as compared with the standard population, which was defined as all residents in Hangzhou city during the same period. RESULTS After three years of follow-up, cancer patients showed elevated incidence risks of CVD (SIR = 1.41, 95%CI: 1.35-1.47) as compared with the standard population. The elevated risks of CVD were highest in the first year after cancer diagnosis (SIR = 1.68, 95%CI: 1.58-1.78), then followed by the second (SIR = 1.21, 95%CI: 1.11-1.31) and the third (SIR = 1.18, 95%CI: 1.07-1.29) year. These results were consistent in males and females. Furthermore, different risks of CVD were observed among different cancer sites. Patients with pancreatic cancer showed the highest risks of CVD, then followed by liver cancer, lung cancer, kidney cancer, gastric cancer, bladder cancer, prostate cancer, and colorectal cancer. CONCLUSIONS Cancer patients have increased incidence risks of CVD, especially in the first year after cancer diagnosis. The increased risks of CVD vary by different cancer sites. Our findings highlight the importance of paying close attention to the CVD risks among cancer patients.
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Affiliation(s)
- Di He
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Kang Qin
- Hangzhou Center for Disease Control and Prevention, 568 Mingshi Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Jun Li
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuhao Li
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhaohui Chen
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jue Xu
- Hangzhou Center for Disease Control and Prevention, 568 Mingshi Road, Shangcheng District, Hangzhou, Zhejiang, China.
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
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18
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Weaver KE, Dressler EV, Smith S, Nightingale CL, Klepin HD, Lee SC, Wells BJ, Hundley WG, DeMari JA, Price SN, Foraker RE. Cardiovascular health assessment in routine cancer follow-up in community settings: survivor risk awareness and perspectives. BMC Cancer 2024; 24:158. [PMID: 38297229 PMCID: PMC10829276 DOI: 10.1186/s12885-024-11912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Guidelines recommend cardiovascular risk assessment and counseling for cancer survivors. For effective implementation, it is critical to understand survivor cardiovascular health (CVH) profiles and perspectives in community settings. We aimed to (1) Assess survivor CVH profiles, (2) compare self-reported and EHR-based categorization of CVH factors, and (3) describe perceptions regarding addressing CVH during oncology encounters. METHODS This cross-sectional analysis utilized data from an ongoing NCI Community Oncology Research Program trial of an EHR heart health tool for cancer survivors (WF-1804CD). Survivors presenting for routine care after potentially curative treatment recruited from 8 oncology practices completed a pre-visit survey, including American Heart Association Simple 7 CVH factors (classified as ideal, intermediate, or poor). Medical record abstraction ascertained CVD risk factors and cancer characteristics. Likert-type questions assessed desired discussion during oncology care. RESULTS Of 502 enrolled survivors (95.6% female; mean time since diagnosis = 4.2 years), most had breast cancer (79.7%). Many survivors had common cardiovascular comorbidities, including high cholesterol (48.3%), hypertension or high BP (47.8%) obesity (33.1%), and diabetes (20.5%); 30.5% of survivors received high cardiotoxicity potential cancer treatment. Less than half had ideal/non-missing levels for physical activity (48.0%), BMI (18.9%), cholesterol (17.9%), blood pressure (14.1%), healthy diet (11.0%), and glucose/ HbA1c (6.0%). While > 50% of survivors had concordant EHR-self-report categorization for smoking, BMI, and blood pressure; cholesterol, glucose, and A1C were unknown by survivors and/or missing in the EHR for most. Most survivors agreed oncology providers should talk about heart health (78.9%). CONCLUSIONS Tools to promote CVH discussion can fill gaps in CVH knowledge and are likely to be well-received by survivors in community settings. TRIAL REGISTRATION NCT03935282, Registered 10/01/2020.
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Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sydney Smith
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Heidi D Klepin
- Section on Hematology-Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Simon Craddock Lee
- Department of Population Health, University of Kansas Medical Center, Mail Stop 1008, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - W Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, 417 N 11th St 4th Floor, Richmond, VA, 23219, USA
| | - Joseph A DeMari
- Section on Gynecologic Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sarah N Price
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Randi E Foraker
- Department of Medicine, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., MSC 8066-22-6602, St. Louis, MO, 63110, USA
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19
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Cao L, Wang X, Yan Y, Ning Z, Ma L, Li Y. Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study. Medicine (Baltimore) 2023; 102:e36705. [PMID: 38134062 PMCID: PMC10735158 DOI: 10.1097/md.0000000000036705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Clinical data has shown that cardiovascular diseases (CVDs) have emerged as a prominent cause of mortality in individuals with hepatocellular carcinoma (HCC). This research aimed to reveal the comorbid effects of CVDs in patients with HCC. The cardiovascular mortality of patients diagnosed with HCC between 2000 and 2014 was compared to that of the general US population. Standardized mortality ratios were calculated to quantify the relative risk of cardiovascular mortality in HCC patients. The cumulative incidence of cardiovascular death (CVD) was estimated using Fine-Gray testing, and independent risk factors for CVD were determined using competing risk models. The results were analyzed using the Kaplan-Meier analysis. The overall SMR for CVD in HCC patients was 11.15 (95% CI: 10.99-11.32). The risk of CVD was significantly higher in patients aged < 55 years (SMR: 56.19 [95% CI: 54.97-57.44]) compared to those aged ≥ 75 years (SMR: 1.86 [95% CI: 1.75-1.97]). This study suggests that patients with HCC are at significant risk of developing CVD. Competing risk analyses indicated that age, grade, tumor size, surveillance, epidemiology, and end results stage, and surgical status were independent risk factors for CVD in patients with HCC. Therefore, patients with HCC require enhanced preventive screening and management of CVDs during and after treatment to improve patient survival.
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Affiliation(s)
- Lizhi Cao
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- University of Shanghai for Science and Technology, Shanghai, China
| | - Xiaoying Wang
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yuzhong Yan
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Zhongping Ning
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Linlin Ma
- University of Shanghai for Science and Technology, Shanghai, China
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yanfei Li
- University of Shanghai for Science and Technology, Shanghai, China
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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20
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Gregory ME, Cao W, Rahurkar S, Jonnalagadda P, Stock JC, Ghazi SM, Reid E, Berk AL, Hebert C, Li L, Addison D. Exploring the Incorporation of a Novel Cardiotoxicity Mobile Health App Into Care of Patients With Cancer: Qualitative Study of Patient and Provider Perspectives. JMIR Cancer 2023; 9:e46481. [PMID: 38085565 PMCID: PMC10751627 DOI: 10.2196/46481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/05/2023] [Accepted: 11/08/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Cardiotoxicity is a limitation of several cancer therapies and early recognition improves outcomes. Symptom-tracking mobile health (mHealth) apps are feasible and beneficial, but key elements for mHealth symptom-tracking to indicate early signs of cardiotoxicity are unknown. OBJECTIVE We explored considerations for the design of, and implementation into a large academic medical center, an mHealth symptom-tracking tool for early recognition of cardiotoxicity in patients with cancer after cancer therapy initiation. METHODS We conducted semistructured interviews of >50% of the providers (oncologists, cardio-oncologists, and radiation oncologists) who manage cancer treatment-related cardiotoxicity in the participating institution (n=11), and either interviews or co-design or both with 6 patients. Data were coded and analyzed using thematic analysis. RESULTS Providers indicated that there was no existing process to enable early recognition of cardiotoxicity and felt the app could reduce delays in diagnosis and lead to better patient outcomes. Signs and symptoms providers recommended for tracking included chest pain or tightness, shortness of breath, heart racing or palpitations, syncope, lightheadedness, edema, and excessive fatigue. Implementation barriers included determining who would receive symptom reports, ensuring all members of the patient's care team (eg, oncologist, cardiologist, and primary care) were informed of the symptom reports and could collaborate on care plans, and how to best integrate the app data into the electronic health record. Patients (n=6, 100%) agreed that the app would be useful for enhanced symptom capture and education and indicated willingness to use it. CONCLUSIONS Providers and patients agree that a patient-facing, cancer treatment-related cardiotoxicity symptom-tracking mHealth app would be beneficial. Additional studies evaluating the role of mHealth as a potential strategy for targeted early cardioprotective therapy initiation are needed.
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Affiliation(s)
- Megan E Gregory
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, Univeristy of Florida, Gainesville, FL, United States
| | - Weidan Cao
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Saurabh Rahurkar
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - James C Stock
- Cardio-Oncology Program, Division of Cardiovascular Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Sanam M Ghazi
- Cardio-Oncology Program, Division of Cardiovascular Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Endia Reid
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Abigail L Berk
- Biomedical Sciences Program, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Courtney Hebert
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Lang Li
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiovascular Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
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21
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Chen YH, Chen CT, Wu HP. Effect of Danshen for improving clinical outcomes in patients with bladder cancer: a retrospective, population-based study. Front Pharmacol 2023; 14:1260683. [PMID: 38146460 PMCID: PMC10749307 DOI: 10.3389/fphar.2023.1260683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction: Traditional Chinese Medicine (TCM) has a broad application in healthcare, with Danshen being a notable herb used in Eastern medicine for cancer treatment. This study aims to explore the relationship between Danshen use and cardiovascular risks among bladder cancer patients. Methods: Patients were selected based on a confirmed diagnosis of bladder cancer with specific inclusion and exclusion criteria to control for certain comorbidities and treatments. Utilizing Taiwan's National Health Insurance data from 2003 to 2013, this retrospective, population-based study identified three groups: 525 patients treated with Danshen, 6,419 patients not treated with TCM, and 4,356 patients treated with TCM but not with Danshen. The Cox proportional hazard model was employed to estimate the risks of Major Adverse Cardiovascular Events (MACE) and mortality while accounting for various confounders. Results: The overall incidence of MACEs was significantly lower in the Danshen group (5%) compared to the TCM (8.1%) and non-TCM (9.9%) groups (p < 0.001). The Cox model revealed that bladder cancer patients treated with Danshen had the lowest risk of MACE (adjusted hazard ratio, 0.56; 95% confidence interval, 0.38-0.84) and all-cause mortality (adjusted hazard ratio, 0.60; 95% confidence interval, 0.44-0.82). Discussion: The findings suggest that Danshen reduces the risk of MACE and all-cause mortality in bladder cancer patients, highlighting its potential benefits. This underpins the necessity for further research to substantiate the cardiovascular benefits of Danshen in bladder cancer patients and potentially broaden its application in oncology healthcare.
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Affiliation(s)
- Yi-Hsin Chen
- Department of Nephrology, Taichung Tzu Chi Hospital, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Artificial Intelligence and Data Science, National Chung Hsing University, Taichung, Taiwan
| | - Chih-Tsung Chen
- Department of Nephrology, Taichung Tzu Chi Hospital, Taichung, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
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22
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Gon Y, Zha L, Sasaki T, Morishima T, Ohno Y, Mochizuki H, Sobue T, Miyashiro I. Heart Disease Mortality in Cancer Survivors: A Population-Based Study in Japan. J Am Heart Assoc 2023; 12:e029967. [PMID: 38014664 PMCID: PMC10727325 DOI: 10.1161/jaha.123.029967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Data on the risk of cardiovascular-related mortality in patients with cancer are limited. METHODS AND RESULTS This retrospective cohort study used data from the Osaka Cancer Registry and vital statistics in Japan between 1985 and 2013. The causes of death were investigated, and the risk of fatal heart disease was analyzed. Standardized mortality ratios were calculated to compare the risk of fatal heart disease between patients with cancer and the general population. Fine and Gray competing risk regression models were used to assess the risk of fatal heart disease among patients with cancer. In total, 682 886 patients with cancer were included in the analysis, and 335 635 patients died during the study period. Heart disease was the leading cause of noncancer deaths, with 10 686 deaths. Among the patients who died of heart disease, 5017 had ischemic heart disease, 3598 had heart failure, 356 had hypertensive disease, and 1715 had other heart diseases. The standardized mortality ratio for heart disease was 2.80 (95% CI, 2.74-2.85). The standardized mortality ratio for ischemic heart disease, heart failure, and hypertensive disease were 3.26 (95% CI, 3.17-3.35), 2.69 (95% CI, 2.60-2.78), and 5.97 (95% CI, 5.38-6.63), respectively. The risk of fatal heart disease increased over time after cancer diagnosis. Men were more likely to die of heart disease than women (subdistribution hazard ratio, 1.08 [95% CI, 1.02-1.16]). The risk of fatal heart disease among cancer survivors has decreased in recent years. CONCLUSIONS Cancer survivors have a higher risk of fatal heart disease than the general population.
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Affiliation(s)
- Yasufumi Gon
- Department of NeurologyOsaka University Graduate School of Medicine, SuitaOsakaJapan
- Cancer Control CenterOsaka International Cancer Institute, Osaka‐shiOsakaJapan
| | - Ling Zha
- Department of Social Medicine, Environmental Medicine and Population ScienceOsaka University Graduate School of Medicine, SuitaOsakaJapan
| | - Tsutomu Sasaki
- Department of NeurologyOsaka University Graduate School of Medicine, SuitaOsakaJapan
| | - Toshitaka Morishima
- Cancer Control CenterOsaka International Cancer Institute, Osaka‐shiOsakaJapan
| | - Yuko Ohno
- Department of Mathematical Health ScienceOsaka University Graduate School of Medicine, SuitaOsakaJapan
| | - Hideki Mochizuki
- Department of NeurologyOsaka University Graduate School of Medicine, SuitaOsakaJapan
| | - Tomotaka Sobue
- Department of Social Medicine, Environmental Medicine and Population ScienceOsaka University Graduate School of Medicine, SuitaOsakaJapan
| | - Isao Miyashiro
- Cancer Control CenterOsaka International Cancer Institute, Osaka‐shiOsakaJapan
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23
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Mitchell JD, Laurie M, Xia Q, Dreyfus B, Jain N, Jain A, Lane D, Lenihan DJ. Risk profiles and incidence of cardiovascular events across different cancer types. ESMO Open 2023; 8:101830. [PMID: 37979325 PMCID: PMC10774883 DOI: 10.1016/j.esmoop.2023.101830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/04/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Cancer survivors are at increased risk for cardiovascular (CV) disease, although additional data are needed to better understand the incidence of CV events across different malignancies. This study sought to characterize the incidence of major adverse CV events [myocardial infarction, stroke, unstable angina (MACE), or heart failure (HF)] across multiple cancer types after cancer diagnosis. PATIENTS AND METHODS Patients were identified from a USA-based administrative claims database who had index cancer diagnoses of breast, lung, prostate, melanoma, myeloma, kidney, colorectal, leukemia, or lymphoma between 2011 and 2019, with continuous enrollment for ≥12 months before diagnosis. Baseline CV risk factors and incidence rates of CV events post-index were identified for each cancer. Multivariable Cox hazards models assessed the cumulative incidence of MACE, accounting for baseline risk factors. RESULTS Among 839 934 patients across nine cancer types, CV risk factors were prevalent. The cumulative incidence of MACE was highest in lung cancer and myeloma, and lowest in breast cancer, prostate cancer, and melanoma. MACE cumulative incidence for lung cancer was 26% by 4 years (2.7-fold higher relative to breast cancer). The incidence of stroke was especially pronounced in lung cancer, while HF was highest in myeloma and lung cancer. CONCLUSIONS CV events were especially increased following certain cancer diagnoses, even after accounting for baseline risk factors. Understanding the variable patient characteristics and associated CV events across different cancers can help target appropriate CV risk factor modification and develop strategies to minimize adverse CV events and improve patient outcomes.
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Affiliation(s)
- J D Mitchell
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, USA; International Cardio-Oncology Society, Tampa, USA.
| | - M Laurie
- Bristol Myers Squibb, Lawrenceville, USA
| | - Q Xia
- Bristol Myers Squibb, Lawrenceville, USA
| | - B Dreyfus
- Bristol Myers Squibb, Lawrenceville, USA
| | - N Jain
- Mu Sigma, Northbrook, USA
| | - A Jain
- Mu Sigma, Northbrook, USA
| | - D Lane
- Bristol Myers Squibb, Lawrenceville, USA
| | - D J Lenihan
- International Cardio-Oncology Society, Tampa, USA; Cape Cardiology Group, Saint Francis Healthcare, Cape Girardeau, USA
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24
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Summey R, Aliani R, McAlarnen LA, Sequeira N, Shaik T, Uyar D, Brown SA. Syndromes of Concurrent Hypertension, Diastolic Dysfunction, and Pulmonary or Peripheral Edema in Cardio-Oncology: Case Studies, Literature Review, and New Classification System. Curr Treat Options Oncol 2023; 24:1917-1934. [PMID: 38091185 DOI: 10.1007/s11864-023-01141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 01/11/2024]
Abstract
OPINION STATEMENT Individuals who have ever been diagnosed with cancer are at increased risk for cardiovascular conditions during and after cancer treatment. Especially during cancer treatment, cardiovascular conditions can manifest in many ways, including peripheral or pulmonary edema. Edema can indicate volume overload affecting the heart even without other unequivocal evidence of apparent diastolic or systolic left ventricular dysfunction, particularly at rest. We propose a novel algorithm to streamline the diagnostic evaluation and cardiovascular classification for cancer patients with edema. We initially advise prompt evaluation with a chest X-ray and echocardiogram. We then suggest classification into one of five categories based on the timing of presentation of edema relative to cancer treatment, as well as echocardiography results and the presence or absence of hypertension or lymphatic causes of edema. This classification tool can then be utilized to guide further cardiovascular management suggestions. These concurrent syndromes presenting as edema may indicate the development or aggravation of undiagnosed diastolic dysfunction with or without hypertension, even if transiently present only while on cancer treatment.
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Affiliation(s)
- Rebekah Summey
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Rana Aliani
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lindsey A McAlarnen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Nicole Sequeira
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Tahseen Shaik
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Denise Uyar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Sherry-Ann Brown
- Cardio-oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
- Preventive Cardio-Oncology LLC, Miami, FL, USA.
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25
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Shao YHJ, Hong JH, Chen CK, Huang CY. Cardiovascular risk of gonadotropin-releasing hormone antagonist versus agonist in men with prostate cancer: an observational study in Taiwan. Prostate Cancer Prostatic Dis 2023; 26:722-729. [PMID: 35662291 PMCID: PMC10638084 DOI: 10.1038/s41391-022-00555-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/16/2022] [Accepted: 05/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The impact of gonadotropin-releasing hormone (GnRH) antagonist and agonist (GnRHa) treatment on cardiovascular disease (CVD) risk in prostate cancer (PCa) remains inconclusive due to conflicting findings. We compared the effects of GnRH antagonist and GnRHa treatments on CVD risk in patients with PCa and pre-existing CVD, in a Taiwan population-based database. METHODS We assessed the risk of major adverse CV events (MACE: ischemic heart disease [IHD], stroke, congestive heart failure [CHF] or all cause deaths) and composite CV events (IHD, stroke, CHF or CV deaths) occurring ≥90 days after androgen deprivation therapy (ADT) initiation in patients with PCa after 90 days of treatment with either GnRH antagonist (degarelix; n = 499) or GnRHa (goserelin, leuprolide, triptorelin; n = 15,127). Patients identified with pre-existing CVD had received cardiac therapy for IHD, reported a stroke or CHF within a year before ADT initiation. Adjusted hazard ratios (aHR) and 95% confidence interval (CI) were obtained for MACE and composite CV events risk after adjusting for age, baseline status of diabetes, hypertension and treatments received. RESULTS All GnRH antagonist-treated patients showed lower risk of composite CV events than the GnRHa-treated patients. The lower composite CV events risk associated with GnRH antagonist was also observed in patients with metastasis at diagnosis (aHR 0.16; 95% CI, 0.04-0.38; p = 0.013) and those receiving ADT for more than six months (aHR 0.30; 95% CI, 0.16-0.54; p < 0.0001). In patients with pre-existing CVD, the MACE risk was 33% lower (aHR 0.67; 95% CI, 0.46-0.96; p = 0.0299) and composite CV events risk was 84% lower (aHR 0.16; 95% CI, 0.05-0.50; p = 0.0017) in GnRH antagonist-treated than the GnRHa-treated patients. CONCLUSIONS In patients with PCa and pre-existing CVD, GnRH antagonist use was associated with lower risks for composite CV events and MACE compared with GnRHa.
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Affiliation(s)
- Yu-Hsuan Joni Shao
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
| | - Jian-Hua Hong
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chun-Kai Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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26
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Decker NS, Johnson T, Vey JA, Le Cornet C, Behrens S, Obi N, Kaaks R, Chang-Claude J, Fortner RT. Circulating oxysterols and prognosis among women with a breast cancer diagnosis: results from the MARIE patient cohort. BMC Med 2023; 21:438. [PMID: 37964298 PMCID: PMC10648629 DOI: 10.1186/s12916-023-03152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed cancer in women worldwide, and underlying mechanistic pathways associated with breast cancer-specific and non-breast cancer-related deaths are of importance. Emerging evidence suggests a role of oxysterols, derivates of cholesterol, in multiple chronic diseases including breast cancer and coronary artery diseases. However, associations between oxysterols and survival have been minimally studied in women diagnosed with breast cancer. In this large breast cancer patient cohort, we evaluated associations between a panel of circulating oxysterols and mortality and recurrence outcomes. METHODS Concentrations of 13 circulating oxysterols representing different pathways of cholesterol metabolism were quantified using liquid-chromatography mass-spectrometry. Associations between baseline levels of oxysterols and cause-specific mortality outcomes and recurrence following a breast cancer diagnosis were assessed in 2282 women from the MARIE study over a median follow-up time of 11 years. We calculated hazard ratios (HR) and 95% confidence intervals (CI) using multivariable Cox proportional hazard models and competing risks models. RESULTS We observed no associations for circulating oxysterols and breast cancer-specific outcomes. Higher levels of six oxysterols were associated with an increased risk of cardiovascular disease death, including 24S-hydroxycholesterol (alternative bile acid pathway, HRlog2 = 1.73 (1.02, 2.93)), lanosterol (cholesterol biosynthesis pathway, HRlog2 = 1.95 (1.34, 2.83)), 7-ketocholesterol (HRlog2 = 1.26 (1.03, 1.55)), 5α,6α-epoxycholesterol (HRlog2 = 1.34 (1.02-1.77)), and 5a,6β-dihydroxycholestanol (HRlog2 = 1.34 (1.03, 1.76)). After adjusting for multiple comparisons, none of the associations were statistically significant. CONCLUSION We provide first evidence on a range of circulating oxysterols and mortality following a breast cancer diagnosis, contributing to a better understanding of associations between different pathways of cholesterol metabolism and prognosis in women with a breast cancer diagnosis. The findings of this study suggest circulating oxysterols may be associated with cardiovascular mortality among women diagnosed with breast cancer. Further studies are needed to evaluate these oxysterols as potential markers of risk for cardiovascular mortality among women with a breast cancer diagnosis as well as their clinical potential.
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Affiliation(s)
- Nina Sophia Decker
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Johannes A Vey
- Institute of Medical Biometry, Heidelberg University, Heidelberg, Germany
| | - Charlotte Le Cornet
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- University Cancer Center Hamburg, Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Renée Turzanski Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
- Department of Research, Cancer Registry of Norway, Ullernchausseen 64, 0379, Oslo, Norway.
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27
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Liao J, Zhou Z. Long-term cardiovascular mortality risk in patients with bladder cancer: a real-world retrospective study of 129,765 cases based on the SEER database. Front Cardiovasc Med 2023; 10:1142417. [PMID: 38028470 PMCID: PMC10666068 DOI: 10.3389/fcvm.2023.1142417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Among 28 cancer types, bladder cancer (BC) patients have the highest risk of dying from cardiovascular disease (CVD). We aimed to identify the independent risk factors and develop a novel nomogram for predicting long-term cardiovascular mortality in patients with BC. Methods We extracted data from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with bladder cancer (BC) between 2000 and 2017. The cumulative incidence function (CIF) was computed for both CVD-related death and other causes of death. Then we performed univariate and multivariate analyses to explore the independent risk factors and further develop a novel nomogram to predict cardiovascular mortality at 5- and 10-year for patients with BC by using the Fine-Gray competing risk model. The efficacy of the developed nomogram was assessed by the concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results A total of 12,9765 patients were randomly divided into training (n = 90,835, 70%), and validation (n = 38,930, 30%) cohorts. During the follow-up period, 31,862 (46.4%) patients died from BC, and 36793 (53.6%) patients died from non-BC, of which CVD-related death accounted for 17,165 (46.7%), being the major cause of non-cancer deaths. The multivariate analysis showed that age, sex, race, marital status, histologic type, tumor grade, summary stage, and chemotherapy were independent risk factors of CVD-related death in BC patients. The nomogram based on the above eight factors showed good discrimination power, excellent consistency, and clinical practicability: (1) the areas under the curve of the ROC for 5- and 10-year CVD-related death of 0.725 and 0.732 in the training cohort and 0.726 and 0.734 in the validation cohort; (2) the calibration curves showed that the prediction probabilities were basically consistent with the observed probabilities; (3) the DCA curves revealed that the nomogram had high positive net benefits. Discussion To our knowledge, this was the first study to identify the independent risk factors and develop a novel nomogram for predicting long-term cardiovascular mortality in patients with BC based on the competing risk model. Our results could help clinicians comprehensively and effectively manage the co-patient of BC and CVD, thereby reducing the risk of cardiovascular mortality in BC survivors.
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Affiliation(s)
| | - Zihua Zhou
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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28
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Contiero P, Boffi R, Borgini A, Fabiano S, Tittarelli A, Mian M, Vittadello F, Epifani S, Ardizzone A, Cirilli C, Boschetti L, Marguati S, Cascone G, Tumino R, Fanetti AC, Giumelli P, Candela G, Scuderi T, Castelli M, Bongiorno S, Barigelletti G, Perotti V, Veronese C, Turazza F, Crivaro M, Tagliabue G. Causes of death in women with breast cancer: a risks and rates study on a population-based cohort. Front Oncol 2023; 13:1270877. [PMID: 38023134 PMCID: PMC10646497 DOI: 10.3389/fonc.2023.1270877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The increasing survival of patients with breast cancer has prompted the assessment of mortality due to all causes of death in these patients. We estimated the absolute risks of death from different causes, useful for health-care planning and clinical prediction, as well as cause-specific hazards, useful for hypothesis generation on etiology and risk factors. Materials and methods Using data from population-based cancer registries we performed a retrospective study on a cohort of women diagnosed with primary breast cancer. We carried out a competing-cause analysis computing cumulative incidence functions (CIFs) and cause-specific hazards (CSHs) in the whole cohort, separately by age, stage and registry area. Results The study cohort comprised 12,742 women followed up for six years. Breast cancer showed the highest CIF, 13.71%, and cardiovascular disease was the second leading cause of death with a CIF of 3.60%. The contribution of breast cancer deaths to the CIF for all causes varied widely by age class: 89.25% in women diagnosed at age <50 years, 72.94% in women diagnosed at age 50-69 and 48.25% in women diagnosed at age ≥70. Greater CIF variations were observed according to stage: the contribution of causes other than breast cancer to CIF for all causes was 73.4% in women with stage I disease, 42.9% in stage II-III and only 13.2% in stage IV. CSH computation revealed temporal variations: in women diagnosed at age ≥70 the CSH for breast cancer was equaled by that for cardiovascular disease and "other diseases" in the sixth year following diagnosis, and an early peak for breast cancer was identified in the first year following diagnosis. Among women aged 50-69 we identified an early peak for breast cancer followed by a further peak near the second year of follow-up. Comparison by geographic area highlighted conspicuous variations: the highest CIF for cardiovascular disease was more than 70% higher than the lowest, while for breast cancer the highest CIF doubled the lowest. Conclusion The integrated interpretation of absolute risks and hazards suggests the need for multidisciplinary surveillance and prevention using community-based, holistic and well-coordinated survivorship care models.
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Affiliation(s)
- Paolo Contiero
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Boffi
- Respiratory Disease Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandro Borgini
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sabrina Fabiano
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Tittarelli
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michael Mian
- Innovation, Research and Teaching Service, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Bozen, Italy
| | | | - Susi Epifani
- Statistics and Epidemiology Unit, ASL Brindisi, Brindisi, Italy
| | | | - Claudia Cirilli
- Servizio di Epidemiologia e Comunicazione del Rischio-Unità Funzionale di Modena, Registro Tumori Regione, Modena, Italy
| | | | - Stefano Marguati
- Pavia Cancer Registry, Public Health Agency of Pavia, Pavia, Italy
| | - Giuseppe Cascone
- Ragusa Cancer Registry Unit, Azienda Sanitaria Provinciale di Ragusa (ASP), Ragusa, Italy
| | - Rosario Tumino
- Ragusa Cancer Registry Unit, Azienda Sanitaria Provinciale di Ragusa (ASP), Ragusa, Italy
| | | | | | | | | | - Maurizio Castelli
- Dipartimento di Prevenzione Azienda USL Valle d’Aosta Loc, Quart, Italy
| | | | - Giulio Barigelletti
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Viviana Perotti
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Veronese
- Respiratory Disease Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Fabio Turazza
- Cardiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina Crivaro
- Cardiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Tagliabue
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Bandettini WP. A Rapid Cardiovascular Magnetic Resonance Assessment for Cancer Therapy-Related Cardiac Dysfunction Supports the Routine Incorporation of Cardiovascular Magnetic Resonance into Cardio-Oncology Care. Am J Cardiol 2023; 206:330-331. [PMID: 37743145 DOI: 10.1016/j.amjcard.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Affiliation(s)
- W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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Li J, Shaikh SN, Uqaili AA, Nasir H, Zia R, Akram MA, Jawad FA, Sohail S, AbdelGawwad MR, Almutairi SM, Elshikh MS, Jamil M, Rasheed RA. A pan-cancer analysis of pituitary tumor-transforming 3, pseudogene. Am J Transl Res 2023; 15:5408-5424. [PMID: 37692950 PMCID: PMC10492052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Although evidence regarding pituitary tumor-transforming 3, pseudogene (PTTG3P) involvement in human cancers has been acquired via human and animal model-based molecular studies, there is a lack of pan-cancer analysis of this gene in human tumors. METHODS Tumor-causing effects of PTTG3P in 24 human tumors were explored using The Cancer Genome Atlas (TCGA) datasets from different bioinformatics databases and applying in silico tools such as The University of ALabama at Birmingham CANcer (UALCAN), Human Protein Atlas (HPA), Kaplan Meier (KM) plotter, cBioPortal, Search Tool for the Retrieval of Interacting Genes/Proteins (STRING), Cytoscape, Database for Annotation, Visualization, and Integrated Discovery (DAVID), Tumor IMmune Estimation Resource (TIMER), and Comparative Toxicogenomics Database (CTD). Then, via in vitro experiments, including RNA sequencing (RNA-seq) and targeted bisulfite sequencing (bisulfite-seq), expression and promoter methylation levels of PTTG3P were verified in cell lines. RESULTS The PTTG3P expression was overexpressed across 23 malignancies and its overexpression was further found significantly effecting the overall survival (OS) durations of the esophageal carcinoma (ESCA) and head and neck cancer (HNSC) patients. This important information helps us to understand that PTTG3P plays a significant role in the development and progression of ESCA and HNSC. As for PTTG3P functional mechanisms, this gene along with its other binding partners was significantly concentrated in "Oocyte meiosis", "Cell cycle", "Ubiquitin mediated proteolysis", and "Progesterone-mediated oocyte maturation". Moreover, ESCA and HNSC tissues having the higher expression of PTTG3P were found to have lower promoter methylation levels of PTTG3P and higher CD8+ T immune cells level. Additionally, PTTG3P expression-regulatory drugs were also explored in the current manuscript for designing appropriate treatment strategies for ESCA and HNSC with respect to PTTG3P expression. CONCLUSION Our pan-cancer based findings provided a comprehensive account of the oncogenic role and utilization of PTTG3P as a novel molecular biomarker of ESCA and HNSC.
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Affiliation(s)
- Jie Li
- The Second Affiliated Hospital of Hainan Medical University Health Management CenterHaikou 570311, Hainan, China
| | - Saima Naz Shaikh
- Department of Physiology, Liaquat University of Medical and Health SciencesJamshoro, Sindh 76090, Pakistan
| | - Arsalan Ahmed Uqaili
- Department of Physiology, Liaquat University of Medical and Health SciencesJamshoro, Sindh 76090, Pakistan
| | - Hilal Nasir
- Clinical and Translational Oncology, Scuola Superiore Meridionale, Naples Federico II UniversityNapoli 80138, Italy
| | - Rabeea Zia
- Pakistan Kidney and Liver Institute and ResearchLahore, Punjab 54000, Pakistan
| | - Muhammad Aitzaz Akram
- University Institute of Biochemistry and Biotechnology, PMAS-Arid Agriculture UniversityRawalpindi 46000, Pakistan
| | - Fahim Ali Jawad
- Centre of Agricultural Biochemistry and Biotechnology, University of Agriculture FaisalabadFaisalabad 38000, Pakistan
| | - Salman Sohail
- Registrar Ophthalmology, Al Shifa Trust Eye HospitalRawalpindi 46000, Pakistan
| | - Mohamed Ragab AbdelGawwad
- Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of SarajevoSarajevo 71210, Bosnia and Herzegovina
| | - Saeedah Musaed Almutairi
- Department of Botany and Microbiology, College of Science, King Saud UniversityP.O. 2455, Riyadh 11451, Saudi Arabia
| | - Mohamed S Elshikh
- Department of Botany and Microbiology, College of Science, King Saud UniversityP.O. 2455, Riyadh 11451, Saudi Arabia
| | - Muhammad Jamil
- PARC Arid Zone Research CenterDera Ismail Khan 29050, Pakistan
| | - Rabab Ahmed Rasheed
- Histology & Cell Biology Department, Faculty of Medicine, King Salman International UniversitySouth Sinai, Egypt
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Daily N, Elson J, Wakatsuki T. Aging Model for Analyzing Drug-Induced Proarrhythmia Risks Using Cardiomyocytes Differentiated from Progeria-Patient-Derived Induced Pluripotent Stem Cells. Int J Mol Sci 2023; 24:11959. [PMID: 37569335 PMCID: PMC10418415 DOI: 10.3390/ijms241511959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Among various cardiac safety concerns, proarrhythmia risks, including QT prolongation leading to Torsade de Pointes, is one of major cause for drugs being withdrawn (~45% 1975-2007). Preclinical study requires the evaluation of proarrhythmia using in silico, in vitro, and/or animal models. Considering that the primary consumers of prescription drugs are elderly patients, applications of "aging-in-a-dish" models would be appropriate for screening proarrhythmia risks. However, acquiring such models, including cardiomyocytes (CMs) derived from induced pluripotent stem cells (iPSCs), presents extensive challenges. We proposed the hypothesis that CMs differentiated from iPSCs derived from Hutchinson-Gilford progeria syndrome (HGPS, progeria) patients, an ultra-rare premature aging syndrome, can mimic the phenotypes of aging CMs. Our objective, therefore, was to examine this hypothesis by analyzing the response of 11 reference compounds utilized by the Food and Drug Administration (FDA)'s Comprehensive in vitro Proarrhythmia Assay (CiPA) using progeria and control CMs. As a sensitive surrogate marker of modulating cardiac excitation-contraction coupling, we evaluated drug-induced changes in calcium transient (CaT). We observed that the 80% CaT peak duration in the progeria CMs (0.98 ± 0.04 s) was significantly longer than that of control CMs (0.70 ± 0.05 s). Furthermore, when the progeria CMs were subjected to four doses of 11 compounds from low-, intermediate-, and high-risk categories, they demonstrated greater arrhythmia susceptibility than control cells, as shown through six-parameter CaT profile analyses. We also employed the regression analysis established by CiPA to classify the 11 reference compounds and compared proarrhythmia susceptibilities between the progeria and control CMs. This analysis revealed a greater proarrhythmia susceptibility in the progeria CMs compared to the control CMs. Interestingly, in both CMs, the compounds categorized as low risk did not exceed the safety risk threshold of 0.8. In conclusion, our study demonstrates increased proarrhythmia sensitivity in progeria CMs when tested with reference compounds. Future studies are needed to analyze underlying mechanisms and further validate our findings using a larger array of reference compounds.
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Wang Y, McCarthy AL, Tuffaha H. Cost-utility analysis of a supervised exercise intervention for women with early-stage endometrial cancer. Support Care Cancer 2023; 31:391. [PMID: 37310516 DOI: 10.1007/s00520-023-07819-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Cardiovascular disease (CVD) is the leading cause of death after treatment for endometrial cancer (EC). There is clinical evidence that exercise significantly reduces the risks of CVD and cancer recurrence in this population; however, it is unclear whether there is value for money in integrating exercise into cancer recovery care for women treated for EC. This paper assesses the long-term cost-effectiveness of a 12-week supervised exercise intervention, as compared with standard care, for women diagnosed with early-stage EC. METHOD A cost-utility analysis was conducted from the Australian health system perspective for a time horizon of 5 years. A Markov cohort model was designed with six mutually exclusive health states: (i) no CVD, (ii) post-stroke, (iii) post-coronary heart disease (CHD), (iv) post-heart failure, (v) post-cancer recurrence, and (vi) death. The model was populated using the best available evidence. Costs and quality-adjusted life years (QALYs) were discounted at 5% annual rate. Uncertainty in the results was explored using one-way and probabilistic sensitivity analyses (PSA). RESULT The incremental cost of supervised exercise versus standard care was AUD $358, and the incremental QALY was 0.0789, resulting in an incremental cost-effectiveness ratio (ICER) of AUD $5184 per QALY gained. The likelihood that the supervised exercise intervention was cost-effective at a willingness-to-pay threshold of AUD $50,000 per QALY was 99.5%. CONCLUSION This is the first economic evaluation of exercise after treatment for EC. The results suggest that exercise is cost-effective for Australian EC survivors. Given the compelling evidence, efforts could now focus on the implementation of exercise as part of cancer recovery care in Australia.
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Affiliation(s)
- Yufan Wang
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - Alexandra L McCarthy
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Haitham Tuffaha
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
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Patel SR, Suero-Abreu GA, Ai A, Ramachandran MK, Meza K, Florez N. Inequity in care delivery in cardio-oncology: dissecting disparities in underrepresented populations. Front Oncol 2023; 13:1124447. [PMID: 37361603 PMCID: PMC10289233 DOI: 10.3389/fonc.2023.1124447] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/03/2023] [Indexed: 06/28/2023] Open
Abstract
It is well known that patients with cancer have a significantly higher cardiovascular mortality risk than the general population. Cardio-oncology has emerged to focus on these issues including risk reduction, detection, monitoring, and treatment of cardiovascular disease or complications in patients with cancer. The rapid advances in early detection and drug development in oncology, along with socioeconomic differences, racial inequities, lack of support, and barriers to accessing quality medical care, have created disparities in various marginalized populations. In this review, we will discuss the factors contributing to disparities in cardio-oncologic care in distinct populations, including Hispanic/Latinx, Black, Asian and Pacific Islander, indigenous populations, sex and gender minorities, and immigrants. Some factors that contribute to differences in outcomes in cardio-oncology include the prevalence of cancer screening rates, genetic cardiac/oncologic risk factors, cultural stressors, tobacco exposure rates, and physical inactivity. We will also discuss the barriers to cardio-oncologic care in these communities from the racial and socioeconomic context. Appropriate and timely cardiovascular and cancer care in minority groups is a critical component in addressing these disparities, and there need to be urgent efforts to address this widening gap.
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Affiliation(s)
- Shruti Rajesh Patel
- Department of Medicine, Division of Oncology, Stanford University and Stanford Cancer Institute, Stanford, CA, United States
| | | | - Angela Ai
- Olive View-University of California, Los Angeles Medical Center, Los Angeles, CA, United States
| | - Maya K. Ramachandran
- Department of Medicine, Division of Oncology, Stanford University and Stanford Cancer Institute, Stanford, CA, United States
| | - Kelly Meza
- Dana Farber Cancer Institute, Boston, MA, United States
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Teece L, Sweeting MJ, Hall M, Coles B, Oliver-Williams C, Welch CA, de Belder MA, Deanfield J, Weston C, Rutherford MJ, Paley L, Kadam UT, Lambert PC, Peake MD, Gale CP, Adlam D. Impact of a Prior Cancer Diagnosis on Quality of Care and Survival Following Acute Myocardial Infarction: Retrospective Population-Based Cohort Study in England. Circ Cardiovasc Qual Outcomes 2023; 16:e009236. [PMID: 37339190 PMCID: PMC10281182 DOI: 10.1161/circoutcomes.122.009236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND An increasing proportion of patients with cancer experience acute myocardial infarction (AMI). We investigated differences in quality of AMI care and survival between patients with and without previous cancer diagnoses. METHODS A retrospective cohort study using Virtual Cardio-Oncology Research Initiative data. Patients aged 40+ years hospitalized in England with AMI between January 2010 and March 2018 were assessed, ascertaining previous cancers diagnosed within 15 years. Multivariable regression was used to assess effects of cancer diagnosis, time, stage, and site on international quality indicators and mortality. RESULTS Of 512 388 patients with AMI (mean age, 69.3 years; 33.5% women), 42 187 (8.2%) had previous cancers. Patients with cancer had significantly lower use of ACE (angiotensin-converting enzyme) inhibitors/angiotensin receptor blockers (mean percentage point decrease [mppd], 2.6% [95% CI, 1.8-3.4]) and lower overall composite care (mppd, 1.2% [95% CI, 0.9-1.6]). Poorer quality indicator attainment was observed in patients with cancer diagnosed in the last year (mppd, 1.4% [95% CI, 1.8-1.0]), with later stage disease (mppd, 2.5% [95% CI, 3.3-1.4]), and with lung cancer (mppd, 2.2% [95% CI, 3.0-1.3]). Twelve-month all-cause survival was 90.5% in noncancer controls and 86.3% in adjusted counterfactual controls. Differences in post-AMI survival were driven by cancer-related deaths. Modeling improving quality indicator attainment to noncancer patient levels showed modest 12-month survival benefits (lung cancer, 0.6%; other cancers, 0.3%). CONCLUSIONS Measures of quality of AMI care are poorer in patients with cancer, with lower use of secondary prevention medications. Findings are primarily driven by differences in age and comorbidities between cancer and noncancer populations and attenuated after adjustment. The largest impact was observed in recent cancer diagnoses (<1 year) and lung cancer. Further investigation will determine whether differences reflect appropriate management according to cancer prognosis or whether opportunities to improve AMI outcomes in patients with cancer exist.
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Affiliation(s)
- Lucy Teece
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Michael J. Sweeting
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (M.H., C.P.G.)
| | - Briana Coles
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Clare Oliver-Williams
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Cathy A. Welch
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Mark A. de Belder
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, United Kingdom (M.A.d.B., J.D., C.W.)
| | - John Deanfield
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, United Kingdom (M.A.d.B., J.D., C.W.)
- Institute of Cardiovascular Science, University College London, United Kingdom (J.D.)
| | - Clive Weston
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, United Kingdom (M.A.d.B., J.D., C.W.)
- Department of Cardiology, Glangwili General Hospital, Carmarthen, United Kingdom (C.W.)
| | - Mark J. Rutherford
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
| | - Lizz Paley
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Umesh T. Kadam
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- Leicester Diabetes Centre, United Kingdom (U.T.K.)
| | - Paul C. Lambert
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (P.C.L.)
| | - Michael D. Peake
- Department of Respiratory Medicine (M.D.P.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (M.H., C.P.G.)
| | - David Adlam
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (D.A.), University of Leicester, United Kingdom
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Chi K, Luo Z, Zhao H, Li Y, Liang Y, Xiao Z, He Y, Zhang H, Ma Z, Zeng L, Zhou R, Feng M, Li W, Rao H, Yi M. The impact of tumor characteristics on cardiovascular disease death in breast cancer patients with CT or RT: a population-based study. Front Cardiovasc Med 2023; 10:1149633. [PMID: 37229229 PMCID: PMC10203988 DOI: 10.3389/fcvm.2023.1149633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background Previous studies focused on the impact of cardiovascular diseases (CVD) risk factors in breast cancer patients with chemotherapy (CT) or radiotherapy (RT). This study aimed to identify the impact of tumor characteristics on CVD death in these patients. Methods Data of female breast cancer patients with CT or RT between 2004 and 2016 were included. The risk factors of CVD death were identified using Cox regression analyses. A nomogram was constructed to evaluate the predicted value of tumor characteristics, and then validated by the concordance indexes (C-index) and calibration curves. Result A total of 28,539 patients were included with an average follow-up of 6.1 years. Tumor size > 45 mm (adjusted HR = 1.431, 95% CI = 1.116-1.836, P = 0.005), regional (adjusted HR = 1.278, 95% CI = 1.048-1.560, P = 0.015) and distant stage (adjusted HR = 2.240, 95% CI = 1.444-3.474, P < 0.001) were risk factors of CVD death for breast cancer patients with CT or RT. The prediction nomogram of tumor characteristics (tumor size and stage) on CVD survival was established. The C-index of internal and external validation were 0.780 (95% Cl = 0.751-0.809), and 0.809 (95% Cl = 0.768-0.850), respectively. The calibration curves showed consistency between the actual observation and nomogram. The risk stratification was also significant distinction (P < 0.05). Conclusion Tumor size and stage were related to the risk of CVD death for breast cancer patients with CT or RT. The management of CVD death risk in breast cancer patients with CT or RT should focus not only on CVD risk factors but also on tumor size and stage.
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Affiliation(s)
- Kaiyi Chi
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Second Clinical College of Guangzhou Medical University, Guangzhou, China
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
| | - Zehao Luo
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
- Department of Clinical Medicine, The Sixth Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Hongjun Zhao
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
- Department of Clinical Medicine, The Sixth Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Yemin Li
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
- Department of Clinical Medicine, The First Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Yinglan Liang
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
- Department of Anesthesiology, The Second Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Zhaoling Xiao
- Department of Clinical Medicine, The Second Clinical College of Guangzhou Medical University, Guangzhou, China
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
| | - Yiru He
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Hanbin Zhang
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
- Department of Radiological Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zaiying Ma
- Department of Clinical Medicine, The Second Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Liangjia Zeng
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
- Department of Clinical Medicine, The First Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Ruoyun Zhou
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Manting Feng
- Department of Clinical Medicine, The Second Clinical College of Guangzhou Medical University, Guangzhou, China
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
| | - Wangen Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huying Rao
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Yi
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Guan T, Jiang Y, Luo Z, Liang Y, Feng M, Lu Z, Yi M, Teng Y, Zhou R, Zeng L, Chi K, Ou C, Chen M. Long-term risks of cardiovascular death in a population-based cohort of 1,141,675 older patients with cancer. Age Ageing 2023; 52:afad068. [PMID: 37192506 DOI: 10.1093/ageing/afad068] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND previous studies have focused on the risk of cardiovascular disease (CVD)-related death in individual cancers, adolescents or all cancers. OBJECTIVE to evaluate the risk of CVD-related death in older patients with cancer. METHODS older patients with cancer (over 65 years) of 16 cancers diagnosed between 1975 and 2018 were screened out from the Surveillance, Epidemiology and End Results program. The proportion of deaths, competing risk regression models, standardized mortality ratios (SMRs) and absolute excess risks (AERs) were used to assess the risk of CVD-related death. RESULTS this study included 1,141,675 older patients (median follow-up: 13.5 years). Of the 16 individual cancers, the risk of CVD death exceeded primary neoplasm death in older patients with cancers of the breast, endometrium, vulva, prostate gland, penis and melanoma of the skin over time (high competing risk group). Compared to the general older population, older patients with cancer had higher SMR and AER of CVD-related death (SMR: 1.58-4.23; AER: 21.16-365.89), heart disease-related death (SMR: 1.14-4.16; AER: 16.29-301.68) and cerebrovascular disease-related death (SMR: 1.11-4.66; AER: 3.02-72.43), with the SMR trend varying with CVD-related death competing risk classifications. The risk of CVD-related death in the high-competing risk group was higher than in the low-competing risk group. CONCLUSIONS for older patients with cancer, six of 16 individual cancers, including breast, endometrium, vulva, prostate gland, penis and melanoma of the skin was at high risk of CVD-related death. Management for long-term cardiovascular risk in older patients with cancer is needed.
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Affiliation(s)
- Tianwang Guan
- The 10th Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Southern Medical University, Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou 510280, China
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou 510280, China
- Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou 510280, China
| | - Yanting Jiang
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Zehao Luo
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Yinglan Liang
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Manting Feng
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Zhenxing Lu
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou 510280, China
- Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou 510280, China
| | - Min Yi
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510180, China
| | - Yintong Teng
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou 510280, China
- Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou 510280, China
| | - Ruoyun Zhou
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Liangjia Zeng
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Kaiyi Chi
- Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China
| | - Caiwen Ou
- The 10th Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Southern Medical University, Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou 510280, China
| | - Minsheng Chen
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou 510280, China
- Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou 510280, China
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Butel-Simoes LE, Haw TJ, Williams T, Sritharan S, Gadre P, Herrmann SM, Herrmann J, Ngo DTM, Sverdlov AL. Established and Emerging Cancer Therapies and Cardiovascular System: Focus on Hypertension-Mechanisms and Mitigation. Hypertension 2023; 80:685-710. [PMID: 36756872 PMCID: PMC10023512 DOI: 10.1161/hypertensionaha.122.17947] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Cardiovascular disease and cancer are 2 of the leading causes of death worldwide. Although improvements in outcomes have been noted for both disease entities, the success of cancer therapies has come at the cost of at times very impactful adverse events such as cardiovascular events. Hypertension has been noted as both, a side effect as well as a risk factor for the cardiotoxicity of cancer therapies. Some of these dynamics are in keeping with the role of hypertension as a cardiovascular risk factor not only for heart failure, but also for the development of coronary and cerebrovascular disease, and kidney disease and its association with a higher morbidity and mortality overall. Other aspects such as the molecular mechanisms underlying the amplification of acute and long-term cardiotoxicity risk of anthracyclines and increase in blood pressure with various cancer therapeutics remain to be elucidated. In this review, we cover the latest clinical data regarding the risk of hypertension across a spectrum of novel anticancer therapies as well as the underlying known or postulated pathophysiological mechanisms. Furthermore, we review the acute and long-term implications for the amplification of the development of cardiotoxicity with drugs not commonly associated with hypertension such as anthracyclines. An outline of management strategies, including pharmacological and lifestyle interventions as well as models of care aimed to facilitate early detection and more timely management of hypertension in patients with cancer and survivors concludes this review, which overall aims to improve both cardiovascular and cancer-specific outcomes.
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Affiliation(s)
- Lloyd E Butel-Simoes
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
- College of Health and Medicine, University of Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Tatt Jhong Haw
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Trent Williams
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Shanathan Sritharan
- Department of Medicine, Hunter New England Local Health District, NSW, Australia
| | - Payal Gadre
- Department of Medicine, Hunter New England Local Health District, NSW, Australia
| | - Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Doan TM Ngo
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Aaron L Sverdlov
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
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Liu Y. A novel cardio-oncology service line model in optimizing care access, quality and equity for large, multi-hospital health systems. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:16. [PMID: 36973756 PMCID: PMC10041762 DOI: 10.1186/s40959-023-00167-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Despite the rapid growth of cardio-oncology as a subspecialty, cancer patients are still underserved from a cardiovascular perspective. A new care model is needed to integrate comprehensive cardio-oncology care with community-based facilities to improve care access, quality, and equity. Here, we present a cardio-oncology service line model for large, multi-hospital health systems to address this need. METHODS An academic cardio-oncology program was first established using a multidisciplinary approach. Five infrastructure elements for a service line model were created, including strategic accountability, standardized care, dedicated resources, patient experience/education, and branding/identity. We then utilized these elements across our healthcare system to establish a quality-controlled and centrally governed cardio-oncology service line structure. Protocols were created to standardize care and ensure consistency and quality, including referral workflow, imaging, cardiotoxicity surveillance, and clinical management. An IRB-approved cardio-oncology registry was established for outcome tracking. RESULTS The standardized cardio-oncology services were expanded to eight hospitals and ten outpatient care centers, including rural outreach offices, resulting in increased patient access and improved clinical quality measures. The service area expanded 17-fold, and an estimated rural population of 204,133 gained access to care. Cardio-oncology office visits increased by approximately 600% three years after implementation of the service line model. CONCLUSIONS A cardio-oncology service line with standardized care is a feasible and effective care model to improve cardio-oncology care quality, patient access, and health equity in large, multi-hospital health systems. It can be used in conjunction with academic cardio-oncology programs to improve the overall cardio-oncology healthcare efficacy in the US.
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Affiliation(s)
- Yan Liu
- Cardio-Oncology Service Line, Ascension Texas, Austin, USA.
- Cardio-Oncology, Institute for Cardiovascular Health, UT Health Austin/Ascension, Austin, USA.
- Dell Medical School, University of Texas at Austin, 1004 W 32nd St #300, Austin, TX, 78705, USA.
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Shu TD, Schumacher FR, Conroy B, Ponsky L, Mahran A, Bukavina L, Calaway A, Markt SC. Disparities in cause-specific mortality by race and sex among bladder cancer patients from the SEER database. Cancer Causes Control 2023; 34:521-531. [PMID: 36882598 DOI: 10.1007/s10552-023-01679-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Previous literature shows that more bladder cancer patients overall die from causes other than the primary malignancy. Given known disparities in bladder cancer outcomes by race and sex, we aimed to characterize differences in cause-specific mortality for bladder cancer patients by these demographics. METHODS We identified 215,252 bladder cancer patients diagnosed with bladder cancer from 2000 to 2017 in the SEER 18 database. We calculated cumulative incidence of death from seven causes (bladder cancer, COPD, diabetes, heart disease, external, other cancer, other) to assess differences in cause-specific mortality between race and sex subgroups. We used multivariable Cox proportional hazards regression and Fine-Gray competing risk models to compare risk of bladder cancer-specific mortality between race and sex subgroups overall and stratified by cancer stage. RESULTS 17% of patients died from bladder cancer (n = 36,923), 30% died from other causes (n = 65,076), and 53% were alive (n = 113,253). Among those who died, the most common cause of death was bladder cancer, followed by other cancer and diseases of the heart. All race-sex subgroups were more likely than white men to die from bladder cancer. Compared to white men, white women (HR: 1.20, 95% CI: 1.17-1.23) and Black women (HR: 1.57, 95% CI: 1.49-1.66) had a higher risk of dying from bladder cancer, overall and stratified by stage. CONCLUSION Among bladder cancer patients, death from other causes especially other cancer and heart disease contributed a large proportion of mortality. We found differences in cause-specific mortality by race-sex subgroups, with Black women having a particularly high risk of dying from bladder cancer.
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Affiliation(s)
- Timothy D Shu
- Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Fredrick R Schumacher
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Britt Conroy
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lee Ponsky
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amr Mahran
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Laura Bukavina
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Adam Calaway
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah C Markt
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Ahadi H, Shokrzadeh M, Hosseini-Khah Z, Ghassemi Barghi N, Ghasemian M, Emami S. Conversion of antibacterial quinolone drug levofloxacin to potent cytotoxic agents. J Biochem Mol Toxicol 2023:e23334. [PMID: 36843476 DOI: 10.1002/jbt.23334] [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: 06/20/2022] [Revised: 01/03/2023] [Accepted: 02/10/2023] [Indexed: 02/28/2023]
Abstract
Levofloxacin, the optical S-(-) isomer of ofloxacin, is a broad-spectrum antibacterial agent widely used to control various infections caused by Gram-positive and Gram-negative bacteria. While the COOH group is necessary for antibacterial activity, its modification can offer anticancer activity to the fluoroquinolone framework. Therefore, several levofloxacin carboxamides 11a-j and 12 containing 5-substituted-1,3,4-thiadiazole residue were synthesized and screened in vitro for their anticancer activity. The in vitro MTT viability assay revealed that the most compounds had significant activity against cancer cells MCF-7, A549, and SKOV3. In particular, the 3-chloro- and 4-fluoro- benzyl derivatives (11b and 11h), with IC50 values of 1.69-4.76 μM were as potent as or better than doxorubicin. It should be noted that the mother quinolone levofloxacin showed no activity on the tested cancer cell lines. The SAR analysis demonstrated that the 3-chloro or 4-fluoro substituent on the S-benzyl moiety had positive effect on the activity. Further in vitro evaluations of the most promising compounds 11b and 11h by flow cytometric analysis and comet test revealed the ability of compounds in the induction of apoptosis and blockage of the cell proliferation at the G1-phase by nuclear fragmentation and DNA degradation in cancer cells. The obtained results demonstrated that the alteration of 6-COOH functional group in the levofloxacin structure and conjugation with a proper heterocyclic pharmacophore is a good strategy to obtain new anticancer agents.
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Affiliation(s)
- Hamideh Ahadi
- Department of Medicinal Chemistry, Student Research Committee, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Shokrzadeh
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Hosseini-Khah
- Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nasrin Ghassemi Barghi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Ghasemian
- Department of Clinical Biochemistry, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Emami
- Department of Medicinal Chemistry and Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
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Yegya-Raman N, Berlin E, Feigenberg SJ, Ky B, Sun L. Cardiovascular Toxicity and Risk Mitigation with Lung Cancer Treatment. Curr Oncol Rep 2023; 25:433-444. [PMID: 36811807 DOI: 10.1007/s11912-023-01387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE OF REVIEW Patients with lung cancer often have concomitant cardiovascular comorbidities and receive potentially cardiotoxic therapies. As oncologic outcomes improve, the relative impact of cardiovascular disease on lung cancer survivors is expected to increase. This review summarizes cardiovascular toxicities observed after treatment for lung cancer, as well as recommended risk mitigation strategies. RECENT FINDINGS A variety of cardiovascular events may be observed after surgery, radiation therapy (RT), and systemic therapy. The risk of cardiovascular events after radiation therapy (RT) is higher than previously appreciated (23-32%), and RT dose to the heart is a modifiable risk factor. Targeted agents and immune checkpoint inhibitors have been associated with cardiovascular toxicities distinct from those of cytotoxic agents; these are rare but can be severe and require prompt intervention. Optimization of cardiovascular risk factors is important at all phases of cancer therapy and survivorship. Recommended practices for baseline risk assessment, preventive measures, and appropriate monitoring are discussed herein.
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Affiliation(s)
- Nikhil Yegya-Raman
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Eva Berlin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Steven J Feigenberg
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Lova Sun
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, West Pavilion, 2nd Floor, Philadelphia, PA, 19104, USA.
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Cardiovascular-Specific Mortality among Gastrointestinal Stromal Tumor Patients: A Population-Based Analysis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2023; 2023:3619306. [PMID: 36825080 PMCID: PMC9943598 DOI: 10.1155/2023/3619306] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/21/2023] [Accepted: 02/04/2023] [Indexed: 02/18/2023]
Abstract
Background The overall risk of cardiovascular mortality (CVM) in cancer survivors has increased with time. The trend of CVM in patients with gastrointestinal stromal tumors (GISTs) remains unclear. This study is aimed at assessing the risks and independent predictors of CVM in GIST patients. Methods Data of the GIST patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019). The standardized mortality ratio (SMR) was used to evaluate the risk of CVM, and a multivariate competing risk model was utilized to identify the predictors for CVM. Results A total of 12,058 patients with GIST were included in this study, of whom 477 (4.0%) patients died of cardiovascular disease (CVD). The SMR for CVM among GIST patients was significantly higher than in the general population (SMR, 3.23, 95% CI: 2.97-3.52), and all categories of CVD were associated with a significantly elevated SMR. The cumulative mortality of CVD was the lowest among all causes of death, while the CVM was the second most common cause of death in patients ≥ 80 years when stratified by age at diagnosis. Furthermore, male sex, older age at diagnosis, White race, unmarried, earlier year of diagnosis, and not receiving chemotherapy were the poor prognostic factors for CVM. Conclusions The CVM risk in GIST patients was significantly higher relative to the general US population. Timely screening and cardioprotective interventions should be implemented to prevent the occurrence of CVM in patients with GIST.
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Chi K, Zhou R, Luo Z, Zhao H, Jiang Y, He B, Li Y, Chen D, Feng M, Liang Y, Yang W, Liu R, Yao D, Lin X, Xu X. Non-cancer-specific survival in patients with primary central nervous system lymphoma: A multi-center cohort study. Front Oncol 2023; 13:1096027. [PMID: 36845683 PMCID: PMC9945279 DOI: 10.3389/fonc.2023.1096027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
Objective The study aimed to evaluate the non-cancer-specific death risk and identify the risk factors affecting the non-cancer-specific survival (NCSS) in patients with primary central nervous system lymphoma (PCNSL). Methods This multi-center cohort study included 2497 patients with PCNSL in the Surveillance, Epidemiology and End Results (SEER) database from 2007 to 2016, with a mean follow-up of 4.54 years. The non-cancer-specific death risk in patients with PCNSL and primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL) was evaluated using the proportion of deaths, standardized mortality ratio (SMR), and absolute excess risk (AER). Univariate and multivariate competing risk regression models were utilized to identify the risk factors of NCSS. Results PCNSL was the most frequent cause of death in PCNSL patients (75.03%). Non-cancer-specific causes constituted a non-negligible portion of death (20.61%). Compared with the general population, PCNSL patients had higher risks of death from cardiovascular disease (CVD) (SMR, 2.55; AER, 77.29), Alzheimer's disease (SMR, 2.71; AER, 8.79), respiratory disease (SMR, 2.12; AER, 15.63), and other non-cancer-specific diseases (SMR, 4.12; AER, 83.12). Male sex, Black race, earlier year of diagnosis (2007-2011), being unmarried, and a lack of chemotherapy were risk factors for NCSS in patients with PCNSL and PCNS-DLBCL (all P < 0.05). Conclusion Non-cancer-specific causes were important competing causes of death in PCNSL patients. More attention is recommended to non-cancer-specific causes of death in the management of PCNSL patients.
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Affiliation(s)
- Kaiyi Chi
- Department of Clinical Medicine, The Second Clinical College of Guangzhou Medical University, Guangzhou, China,Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
| | - Ruoyun Zhou
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China,Department of Clinical Medicine, The Third Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Zehao Luo
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China,Department of Clinical Medicine, The Sixth Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Hongjun Zhao
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China,Department of Clinical Medicine, The Sixth Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Yanting Jiang
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China,Department of Clinical Medicine, The Sixth Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Baixin He
- Department of Clinical Medicine, The Second Clinical College of Guangzhou Medical University, Guangzhou, China,Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
| | - Yemin Li
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China,Department of Clinical Medicine, The First Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Dongting Chen
- Department of Clinical Medicine, The Second Clinical College of Guangzhou Medical University, Guangzhou, China,Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
| | - Manting Feng
- Department of Clinical Medicine, The Second Clinical College of Guangzhou Medical University, Guangzhou, China,Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China
| | - Yinglan Liang
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China,Department of Anesthesiology, The Second Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Wenting Yang
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China,Department of Medical Imageology, The Second Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Ruisi Liu
- Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China,Department of Medical Imageology, The Second Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Dunchen Yao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaozhen Lin
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,*Correspondence: Xiaozhen Lin, ; Xiuhong Xu,
| | - Xiuhong Xu
- Department of Acupuncture and Massage Rehabilitation, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China,*Correspondence: Xiaozhen Lin, ; Xiuhong Xu,
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Seasonal Pattern of Cerebrovascular Fatalities in Cancer Patients. Healthcare (Basel) 2023; 11:healthcare11040456. [PMID: 36832989 PMCID: PMC9957084 DOI: 10.3390/healthcare11040456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Cancer patients are at increased risk of cerebrovascular events. The incidence of those events and the associated mortality are known to follow a seasonal pattern in the general population. However, it is unclear whether cerebrovascular mortality in cancer patients has seasonal variation. To address this question, we performed a retrospective analysis of the seasonality of deaths due to the fact of cerebrovascular diseases among patients with first primary malignancy registered between 1975 and 2016 in the SEER database. The presence of seasonality in death rates was modeled using the cosinor approach assuming a circa-annual pattern. A significant seasonal pattern with a peak in the first half of November was identified in all patient groups. The same peak was observed in almost all subgroups of patients defined based on demographic characteristics. However, not all entity-defined subgroups showed a seasonal pattern, which might be explained by the different pathologic processes affecting the circulatory system in each cancer type. Based on our findings, one can propose that the active monitoring of cancer patients for cerebrovascular events from the late autumn and during the winter can help in the reduction of mortality in this patient population.
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Wang Z, Fan Z, Yang L, Liu L, Sheng C, Song F, Huang Y, Chen K. Higher risk of cardiovascular mortality than cancer mortality among long-term cancer survivors. Front Cardiovasc Med 2023; 10:1014400. [PMID: 36760569 PMCID: PMC9905625 DOI: 10.3389/fcvm.2023.1014400] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023] Open
Abstract
Background Previous studies focused more on the short-term risk of cardiovascular (CV) death due to traumatic psychological stress after a cancer diagnosis and the acute cardiotoxicity of anticancer treatments than on the long-term risk of CV death. Methods Time trends in the proportions of CV death (PCV), cancer death (PCA), and other causes in deaths from all causes were used to show preliminary relationships among the three causes of death in 4,806,064 patients with cancer from the Surveillance, Epidemiology, and End Results (SEER) program. Competing mortality risk curves were used to investigate when the cumulative CV mortality rate (CMRCV) began to outweigh the cumulative cancer mortality rate (CMRCA) for patients with cancer who survived for more than 10 years. Multivariable competing risk models were further used to investigate the potential factors associated with CV death. Results For patients with cancer at all sites, the PCV increased from 22.8% in the 5th year after diagnosis to 31.0% in the 10th year and 35.7% in the 20th year, while the PCA decreased from 57.7% in the 5th year after diagnosis to 41.2 and 29.9% in the 10th year and 20th year, respectively. The PCV outweighed the PCA (34.6% vs. 34.1%) since the 15th year for patients with cancer at all sites, as early as the 9th year for patients with colorectal cancer (37.5% vs. 33.2%) and as late as the 22nd year for patients with breast cancer (33.5% vs. 30.6%). The CMRCV outweighed the CMRCA since the 25th year from diagnosis. Multivariate competing risk models showed that an increased risk of CV death was independently associated with older age at diagnosis [hazard ratio and 95% confidence intervals [HR (95%CI)] of 43.39 (21.33, 88.28) for ≥ 80 vs. ≤ 30 years] and local metastasis [1.07 (1.04, 1.10)] and a decreased risk among women [0.82 (0.76, 0.88)], surgery [0.90 (0.87, 0.94)], and chemotherapy [0.85 (0.81, 0.90)] among patients with cancer who survived for more than 10 years. Further analyses of patients with cancer who survived for more than 20 years and sensitivity analyses by cancer at all sites showed similar results. Conclusion CV death gradually outweighs cancer death as survival time increases for most patients with cancer. Both the cardio-oncologist and cardio-oncology care should be involved to reduce CV deaths in long-term cancer survivors.
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Affiliation(s)
- Zhipeng Wang
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Zeyu Fan
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Lei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lifang Liu
- Department of Statistics, European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Chao Sheng
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Fengju Song
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China,Fengju Song,
| | - Yubei Huang
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China,*Correspondence: Yubei Huang,
| | - Kexin Chen
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China,Kexin Chen,
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Bruhn J, Malmborg M, Garred CH, Ravn P, Zahir D, Andersson C, Gislason G, Torp-Pedersen C, Kragholm K, Fosbol E, Butt JH, Lang NN, Petrie MC, McMurray J, Kober L, Schou M. Temporal trends in the incidence of malignancy in heart failure: a nationwide Danish study. Eur Heart J 2023; 44:1124-1132. [PMID: 36691953 DOI: 10.1093/eurheartj/ehac797] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/23/2022] [Accepted: 12/19/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS Cancer and heart failure (HF) share risk factors, pathophysiological mechanisms, and possibly genetics. Improved HF survival may increase the risk of cancer due to a competing risk. Whether the incidence of cancer has increased over time in patients with HF as survival has improved is unclear. Therefore, temporal trends of new onset cancer in HF patients between 1997 and 2016 were investigated. METHODS AND RESULTS Using Danish nationwide registers, 103 711 individuals alive, free of cancer, and aged 30-80 years 1 year after HF diagnosis (index date) were included between 1 January 1997 and 31 December 2016. A five-year incidence rate of cancer for each year after index date was calculated. The median age and proportion of women at the index date decreased with advancing calendar time [1997-2001: 70.3 interquartile range (Q1-Q3 62.5-75.7), 60.9% men; 2012-16: 67.6 (59.2-73.8), 67.5% men]. The five-year incidence rate of cancer was 20.9 and 20.2 per 1,000 person-years in 1997 and 2016, respectively. In a multivariable Cox regression model, the hazard rates between index years 1997 (reference) and 2016 were not significantly different [hazard ratio 1.09 (0.97-1.23)]. The five-year absolute risk of cancer did not change with advancing calendar year, going from 9.0% (1997-2001) to 9.0% (2012-16). Five-year cumulative incidence of survival for HF patients increased with advancing calendar year, going from 55.9% (1997-2001) to 74.3% (2012-2016). CONCLUSION Although cancer rates during 1997-2016 have remained stable within 1-6 years after the HF diagnosis, long-term survival following a HF diagnosis has increased significantly.
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Affiliation(s)
- Jonas Bruhn
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
| | - Morten Malmborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Caroline H Garred
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
| | - Pauline Ravn
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
| | - Deewa Zahir
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
| | - Charlotte Andersson
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston, MA, USA
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Emil Fosbol
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ninian N Lang
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - John McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Lars Kober
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Copenhagen, Denmark
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Jung YS, Lee D, Jung KW, Cho H. Long-term Survivorship and Non-cancer Competing Mortality in Head and Neck Cancer: A Nationwide Population-Based Study in South Korea. Cancer Res Treat 2023; 55:50-60. [PMID: 35698446 PMCID: PMC9873318 DOI: 10.4143/crt.2021.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 06/10/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE As the survival of head and neck cancer (HNC) improves, survivors increasingly confront non-cancer-related deaths. This nationwide population-based study aimed to investigate non-cancer-related deaths in HNC survivors. MATERIALS AND METHODS Data from the Korean Central Cancer Registry were obtained to characterize causes of death, mortality patterns, and survival in patients with HNC between 2006 and 2016 (n=40,890). Non-cancer-related mortality relative to the general population was evaluated using standardized mortality ratios (SMRs). The 5- and 10-year cause-specific competing risks probabilities of death (cumulative incidence function, CIF) and subdistribution hazards ratios (sHR) from the Fine-Gray models were estimated. RESULTS Comorbidity-related mortality was frequent in older patients, whereas suicide was predominant in younger patients. The risk of suicide was greater in patients with HNC than in the general population (SMR, 3.1; 95% confidence interval [CI], 2.7 to 3.5). The probability of HNC deaths reached a plateau at 5 years (5-year CIF, 33.9%; 10-year CIF, 39.5%), whereas the probability of non-HNC deaths showed a long-term linear increase (5-year, CIF 5.6%; 10-year CIF, 11.9%). Patients who were male (sHR, 1.56; 95% CI, 1.41 to 1.72), diagnosed with early-stage HNC (localized vs. distant: sHR, 1.86; 95% CI, 1.58 to 2.21) and older age (65-74 vs. 0-44: sHR, 6.20; 95% CI, 4.92 to 7.82; ≥ 75 vs. 0-44: sHR, 9.81; 95% CI, 7.76 to 12.39) had an increased risk of non-cancer mortality. CONCLUSION Non-HNC-related deaths continue increasing. HNC survivors are at increased risk of suicide in the younger and comorbidity-related death in the older. Better population-specific surveillance awareness and survivorship plans for HNC survivors are warranted.
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Affiliation(s)
- Yuh-Seog Jung
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang,
Korea,Department of Otorhinolaryngology Head and Neck Surgery, Center for Thyroid Cancer, Goyang,
Korea,Division of Tumor Immunology, National Cancer Center, Goyang,
Korea
| | - Dahhay Lee
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang,
Korea
| | - Kyu-Won Jung
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang,
Korea
| | - Hyunsoon Cho
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang,
Korea,Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang,
Korea,Department of Cancer AI and Digital Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang,
Korea
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Mo Y, Tian B, Wu M, Chen M, Chen D, Yu J. Dual effect of radiotherapy related concomitant cardiovascular diseases in non-small cell lung cancer. Cancer Med 2023; 12:1025-1034. [PMID: 35754191 PMCID: PMC9883436 DOI: 10.1002/cam4.4948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/12/2022] [Accepted: 05/28/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nowadays, cancer and cardiac diseases are two of the most causes of death, so cancer treatment-related cardiac death cannot be ignored. For lung cancer, chest radiotherapy (RT) is essential, but the related cardiotoxicity has not been fully studied. METHODS We reviewed the data of 11,455 patients with non-small cell lung cancer (NSCLC) from the Surveillance, Epidemiology, and End Results database from 2001 to 2015. The change trend for concomitant cardiovascular diseases (CVD)-specific death was calculated and graphically demonstrated. Univariate and multivariate analyses for survival were performed using Cox risk regression model. RESULTS In our analysis, the overall incidence and mortality from NSCLC declined, but CVD-specific death increased. Both chemoradiotherapy and radiotherapy alone played a significant role in CVD-specific death. Analyzed longitudinally from diagnosis, we found that the effect of RT in CVD-specific death increased continuously over the third years and the hazard ratio for CVD-specific death was 1.386 times between RT and non-RT group (HR = 1.386, 95% CI 1.322-1.452; p < 0.0001). On the other hand, RT played a protective role in CVD-specific death before the second years, especially in recent years from 2013 to 2015 (HR = 0.843, 95% CI 0.740-0.959; p = 0.009). CONCLUSIONS Although the mortality from NSCLC decreased, but radiotherapy-related CVD-specific mortality cannot be ignored. In the long-term over 3 years, RT significantly promoted CVD-specific death. However, RT turned to be a protective role in the short-term within 2 years. In clinical practice, we need to comprehensively consider the dual effects of radiotherapy on the side effect of heart.
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Affiliation(s)
- You Mo
- Shantou University Medical College, Shantou, China;Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Baoqing Tian
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Meng Wu
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Minxin Chen
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Dawei Chen
- Shantou University Medical College, Shantou, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- Shantou University Medical College, Shantou, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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49
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Raisi-Estabragh Z, Kobo O, Freeman P, Petersen SE, Kolman L, Miller RJH, Roguin A, Van Spall HGC, Vuong J, Yang EH, Mamas MA. Temporal trends in disease-specific causes of cardiovascular mortality amongst patients with cancer in the USA between 1999 and 2019. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 9:54-63. [PMID: 35435219 PMCID: PMC9745666 DOI: 10.1093/ehjqcco/qcac016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022]
Abstract
AIMS We report disease-specific cardiovascular causes of mortality among cancer patients in the USA between 1999 and 2019, considering temporal trends by age, sex, and cancer site. METHODS AND RESULTS We used the Multiple Cause of Death database, accessed through the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research resource. We included 629 308 decedents with cardiovascular disease (CVD) recorded as the primary cause of death and active malignancy listed as a contributing cause of death. We created disease-specific CVD categories and grouped cancers by site. We calculated the proportion of CVD deaths attributed to each disease category stratified by sex, age, and cancer site. We also examined disease-specific temporal trends by cancer site. Ischaemic heart disease (IHD) was the most common cardiovascular cause of death across all cancer types (55.6%), being more common in men (59.8%), older ages, and in those with lung (67.8%) and prostate (58.3%) cancers. Cerebrovascular disease (12.9%) and hypertensive diseases (7.6%) were other common causes of death. The proportion of deaths due to heart failure was greatest in haematological (7.7%) and breast (6.3%) cancers. There was a decreasing temporal trend in the proportion of cardiovascular deaths attributed to IHD across all cancer types. The proportion of deaths due to hypertensive diseases showed the greatest percentage increase, with the largest change in breast cancer patients (+191.1%). CONCLUSION We demonstrate differential cardiovascular mortality risk by cancer site and demographics, providing insight into the evolving healthcare needs of this growing high-cardiovascular risk population.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
| | - Phillip Freeman
- Cardiology Department, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Health Data Research UK, London, UK
| | - Louis Kolman
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | | | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, Department of Medicine, Population Health Research Institute, Research Institute of St. Joe's, McMaster University, Hamilton, ON, Canada
| | - Jacqueline Vuong
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA
- Institute of Population Health, University of Manchester, Manchester, UK
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50
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Jin K, Brennan PM, Poon MTC, Figueroa JD, Sudlow CLM. Impact of tumour characteristics and cancer treatment on cerebrovascular mortality after glioma diagnosis: Evidence from a population-based cancer registry. Front Oncol 2022; 12:1025398. [PMID: 36568237 PMCID: PMC9780584 DOI: 10.3389/fonc.2022.1025398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Objective We aimed to examine brain tumour grade, a marker of biological aggressiveness, tumour size and cancer treatment are associated with cerebrovascular mortality among patients with malignant glioma, the most common and aggressive type of brain tumour. Methods We conducted a retrospective, observational cohort study using the US National Cancer Institute's state and regional population-based cancer registries. We identified adult patients with glioma in 2000 to 2018 (N=72,916). The primary outcome was death from cerebrovascular disease. Cox regression modelling was used to estimate the associations with cerebrovascular mortality of tumour grade, tumour size and treatment (surgery, radiotherapy, chemotherapy), calculating hazard ratios (HR) adjusted for these factors as well as for age, sex, race, marital status and calendar year. Results Higher grade (Grade IV vs Grade II: HR=2.47, 95% CI=1.69-3.61, p<0.001) and larger brain tumours (size 3 to <6 cm: HR=1.40, 95% CI=1.03 -1.89, p<0.05; size ≥ 6 cm: HR=1.47, 95% CI=1.02-2.13, p<0.05 compared to size < 3cm) were associated with increased cerebrovascular mortality. Cancer treatment was associated with decreased risk (surgery: HR= 0.60, p<0.001; chemotherapy: HR=0.42, p<0.001; radiation: HR= 0.69, p<0.05). However, among patents surviving five years or more from cancer diagnosis radiotherapy was associated with higher risk of cerebrovascular mortality (HR 2.73, 95% CI 1.49-4.99, p<0.01). Conclusion More aggressive tumour characteristics are associated with increased cerebrovascular mortality. Radiotherapy increased risk of cerebrovascular mortality five-year after cancer diagnosis. Further research is needed to better understand the long-term cardiovascular consequences of radiation therapy, and whether the consequent risk can be mitigated.
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Affiliation(s)
- Kai Jin
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul M. Brennan
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael T. C. Poon
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonnie D. Figueroa
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Cathie L. M. Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Brain Tumour Centre of Excellence, Cancer Research United Kingdom Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
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