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Obeidat O, Obeidat A, Abughazaleh S, Obeidat A, Daise M, Ismail MF, Alqudah Q, Al-Ani H, Tarawneh M, Pondicherry-Harish R. Unveiling Hidden Battles: Exploring the Link Between Breast Cancer Survival and Heart Failure Vulnerability. Angiology 2024:33197241255168. [PMID: 38756005 DOI: 10.1177/00033197241255168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
This study explores the link between a history of breast cancer and the vulnerability to heart failure. Analyzing data from the National Inpatient Sample (NIS) for women diagnosed with breast cancer between 2016 and 2019 in the US, our research utilized logistic regression, adjusting for demographics, comorbidities, and lifestyle factors, and employed propensity score matching. With 2,276,639 weighted cases, our findings reveal a slight but significant elevation in heart failure risk among the breast cancer cohort, specifically in acute, chronic, and isolated systolic heart failure types. Racial differences were pronounced; Black women with breast cancer showed higher risks for all heart failure types, particularly chronic and systolic, while Asian or Pacific Islander patients had a lower incidence of certain heart failure types. This research underscores a modest increase in heart failure risk post-breast cancer, highlighting the critical need for integrated cardio-oncology care and personalized healthcare approaches to address and mitigate this risk effectively.
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Affiliation(s)
- Omar Obeidat
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA
| | - Abedallah Obeidat
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Saeed Abughazaleh
- St Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, MA, USA
| | - Ali Obeidat
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Moh'd Daise
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA
| | - Mohamed F Ismail
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA
| | - Qusai Alqudah
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA
| | - Hashim Al-Ani
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA
| | - Mohammad Tarawneh
- St Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, MA, USA
| | - Roja Pondicherry-Harish
- University of Central Florida College of Medicine, Graduate Medical Education/HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, FL, USA
- The Cardiac and Vascular Institute, Gainesville, FL, USA
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2
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Vasbinder A, Cheng RK, Heckbert SR, Thompson H, Zaslavksy O, Chlebowski RT, Shadyab AH, Johnson L, Wactawski-Wende J, Wells G, Yung R, Martin LW, Paskett ED, Reding K. Chronic Oxidative Stress as a Marker of Long-term Radiation-Induced Cardiovascular Outcomes in Breast Cancer. J Cardiovasc Transl Res 2023; 16:403-413. [PMID: 36178659 PMCID: PMC10060433 DOI: 10.1007/s12265-022-10320-2] [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: 04/05/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
While biomarkers have been proposed to identify individuals at risk for radiation-induced cardiovascular disease (RICVD), little is known about long-term associations with cardiac events. We examined associations of biomarkers of oxidative stress (myeloperoxidase, growth differentiation factor-15, 8-hydroxy-2'-deoxyguanosine [8-OH-dG], placental growth factor), cardiac injury (troponin I, cystatin-C), inflammation (interleukin-6, C-reactive protein), and myocardial fibrosis (transforming growth factor-ß) with long-term RICVD in breast cancer (BC) survivors. We conducted a nested case-control study within the Women's Health Initiative of postmenopausal women with incident BC stages I-III, who received radiation and had pre- and post-BC diagnosis serum samples. Cases (n = 55) were defined as developing incident, physician-adjudicated myocardial infarction, coronary heart disease death, other CVD death, heart failure, or stroke after BC. Cases were matched to three controls (n = 158). After adjustment, a higher 8-OH-dG ratio was significantly associated with an elevated long-term risk of RICVD, suggesting oxidative DNA damage may be a putative pathway for RICVD.
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Affiliation(s)
- Alexi Vasbinder
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, USA
| | - Richard K Cheng
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, USA
| | - Susan R Heckbert
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Hilaire Thompson
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, USA
| | - Oleg Zaslavksy
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, USA
| | - Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, USA
| | - Lisa Johnson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo, Buffalo, USA
| | - Gretchen Wells
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington-Fayette, USA
| | - Rachel Yung
- Division of Medical Oncology, University of Washington, Seattle, USA
| | - Lisa Warsinger Martin
- Division of Cardiology, School of Medicine and Health Sciences, George Washington University, Seattle, USA
| | - Electra D Paskett
- Comprehensive Cancer Center, Department of Medicine, The Ohio State University, Columbus, USA
| | - Kerryn Reding
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, USA.
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Vasbinder A, Thompson H, Zaslavksy O, Heckbert SR, Saquib N, Shadyab AH, Chlebowski RT, Warsinger Martin L, Paskett ED, Reding KW. Inflammatory, Oxidative Stress, and Cardiac Damage Biomarkers and Radiation-Induced Fatigue in Breast Cancer Survivors. Biol Res Nurs 2022; 24:472-483. [PMID: 35527686 PMCID: PMC9630726 DOI: 10.1177/10998004221098113] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE Studies examining biomarkers associated with fatigue in breast cancer survivors treated with radiation are limited. Therefore, we examined the longitudinal association between serum biomarkers and post-breast cancer fatigue in survivors treated with radiation: [oxidative stress] 8-hydroxyguanosine, myeloperoxidase; [inflammation] interleukin-6 (IL-6), c-reactive protein, growth differentiation factor-15 (GDF-15), placental growth factor, transforming growth factor-beta, [cardiac damage] cystatin-C, troponin-I. METHODS In a secondary analysis, we included participants from the Women's Health Initiative if they had: a previous breast cancer diagnosis (stages I-III), no prior cardiovascular diseases, pre-and post-breast cancer serum samples drawn approximately 3 years apart, and fatigue measured using the Short-Form 36 vitality subscale at both serum collections. Biomarkers were measured using ELISA or RT-qPCR and modeled as the log2 post-to pre-breast cancer ratio. RESULTS Overall, 180 women with a mean (SD) age of 67.0 (5.5) years were included. The mean (SD) vitality scores were 66.2 (17.2) and 59.7 (19.7) pre- and post-breast cancer, respectively. Using multivariable weighted linear regression, higher biomarker ratios of cystatin-C, IL-6, and GDF-15 were associated with a lower vitality score (i.e., higher fatigue). For example, for each 2-fold difference in cystatin-C biomarker ratio, the vitality score was lower by 7.31 points (95% CI: -14.2, -0.45). CONCLUSION Inflammatory and cardiac damage biomarkers are associated with fatigue in breast cancer survivors treated with radiation; however, these findings should be replicated in a larger sample. Biomarkers could be measured in clinical practice or assessed in risk prediction models to help identify patients at high risk for fatigue.
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Affiliation(s)
- Alexi Vasbinder
- Department of Biobehavioral Nursing
and Health Informatics, School of Nursing, University of
Washington, Seattle, WA, USA
| | - Hilaire Thompson
- Department of Biobehavioral Nursing
and Health Informatics, School of Nursing, University of
Washington, Seattle, WA, USA
| | - Oleg Zaslavksy
- Department of Biobehavioral Nursing
and Health Informatics, School of Nursing, University of
Washington, Seattle, WA, USA
| | - Susan R. Heckbert
- Department of Epidemiology, School
of Public Health, University of
Washington, Seattle, WA, USA
| | - Nazmus Saquib
- Research Unit, College of Medicine, Sulaiman AlRajhi
University, Al Bukayriyah, Saudi Arabia
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public
Health and Human Longevity Science, University of
California, San Diego, CA, USA
| | - Rowan T. Chlebowski
- Lundquist Institute for Biomedical
Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Lisa Warsinger Martin
- Division of Cardiology, School of
Medicine and Health Sciences, George Washington
University, Washington, DC, USA
| | - Electra D. Paskett
- Department of Medicine,
Comprehensive Cancer Center, The Ohio State
University, Columbus, OH, USA
| | - Kerryn W. Reding
- Department of Biobehavioral Nursing
and Health Informatics, School of Nursing, University of
Washington, Seattle, WA, USA
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Diaz A, Sverdlov AL, Kelly B, Ngo DTM, Bates N, Garvey G. Nexus of Cancer and Cardiovascular Disease for Australia's First Peoples. JCO Glob Oncol 2021; 6:115-119. [PMID: 32031450 PMCID: PMC6998018 DOI: 10.1200/jgo.19.00088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Abbey Diaz
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Aaron L Sverdlov
- University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Brian Kelly
- University of Newcastle, Callaghan, New South Wales, Australia.,University of New England, Armidale, New South Wales, Australia.,University of Calgary, Calgary, Alberta, Canada
| | - Doan T M Ngo
- University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Nicole Bates
- James Cook University, Townsville, Queensland, Australia
| | - Gail Garvey
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
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5
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Koczwara B, Meng R, Miller MD, Clark RA, Kaambwa B, Marin T, Damarell RA, Roder DM. Late mortality in people with cancer: a population-based Australian study. Med J Aust 2020; 214:318-323. [PMID: 33296507 DOI: 10.5694/mja2.50879] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate causes of death of people with cancer alive five years after diagnosis, and to compare mortality rates for this group with those of the general population. DESIGN, SETTING, PARTICIPANTS Retrospective cohort study; analysis of South Australian Cancer Registry data for all people diagnosed with cancer during 1990-1999 and alive five years after diagnosis, with follow-up to 31 December 2016. MAIN OUTCOME MEASURES All-cause and cancer cause-specific mortality, by cancer diagnosis; standardised mortality ratios (study group v SA general population) by sex, age at diagnosis, follow-up period, and index cancer. RESULTS Of 32 646 people with cancer alive five years after diagnosis, 30 309 were of European background (93%) and 16 400 were males (50%); the mean age at diagnosis was 60.3 years (SD, 15.7 years). The median follow-up time was 17 years (IQR, 11-21 years); 17 268 deaths were recorded (53% of patients; mean age, 80.6 years; SD, 11.4 years): 7845 attributed to cancer (45% of deaths) and 9423 attributed to non-cancer causes (55%). Ischaemic heart disease was the leading cause of death (2393 deaths), followed by prostate cancer (1424), cerebrovascular disease (1175), and breast cancer (1118). The overall standardised mortality ratio (adjusted for age, sex, and year of diagnosis) was 1.24 (95% CI, 1.22-1.25). The cumulative number of cardiovascular deaths exceeded that of cancer cause-specific deaths from 13 years after cancer diagnosis. CONCLUSIONS Mortality among people with cancer who are alive at least five years after diagnosis was higher than for the general population, particularly cardiovascular disease-related mortality. Survivorship care should include early recognition and management of risk factors for cardiovascular disease.
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Affiliation(s)
- Bogda Koczwara
- Flinders Medical Centre, Adelaide, SA.,Flinders University, Adelaide, SA
| | | | | | | | | | | | | | - David M Roder
- Cancer Research Institute, University of South Australia, Adelaide, SA
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Manolis AA, Manolis TA, Mikhailidis DP, Manolis AS. Cardiovascular safety of oncologic agents: A double-edged sword even in the era of targeted therapies - part 1. Expert Opin Drug Saf 2018; 17:875-892. [PMID: 30126304 DOI: 10.1080/14740338.2018.1513488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Patients with cancer are subject to the cardiotoxic effects of cancer therapy and as more patients survive cancer due to improved treatment they are exposed to various forms of cardiovascular (CV) disease as they age, and vice-versa. Such an interplay of age with both malignancy and CV disease may contribute to increased morbidity and mortality. AREAS COVERED This two-part review considers the effects of cancer drug treatment on the CV system. In Part I, the various types of CV and cardiometabolic toxicity of anti-cancer drugs and the possible mechanisms involved are discussed. Also, among the specific oncologic agents, the CV effects of the classical agents and of the large molecule immunological agents (monoclonal antibodies, including immune checkpoint inhibitors) are detailed. EXPERT OPINION Oncologic agents produce a variety of CV adverse effects, including cardiomyopathy and heart failure, peri-myocarditis, coronary artery disease, peripheral vascular disease, hypertension (HTN), cardiac arrhythmias, valvular heart disease, and pulmonary HTN. Both the oncologist and the cardiologist need to be aware of such adverse effects and of the specific agents that produce them. They need to join forces to prevent, anticipate, recognize, and manage such complications.
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Affiliation(s)
| | | | - Dimitri P Mikhailidis
- c Department of Clinical Biochemistry , University College London Medical School , London , UK
| | - Antonis S Manolis
- d Third Department of Cardiology , Athens University School of Medicine , Athens , Greece
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7
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Koutsoukis A, Ntalianis A, Repasos E, Kastritis E, Dimopoulos MA, Paraskevaidis I. Cardio-oncology: A Focus on Cardiotoxicity. Eur Cardiol 2018; 13:64-69. [PMID: 30310475 DOI: 10.15420/ecr.2017:17:2] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cardio-oncology is a recently developed field in cardiology aimed at significantly reducing cardiovascular morbidity and mortality and improving quality of life in cancer survivors. Cancer survival rates have been constantly increasing, mainly because of the advent of new, more potent and targeted therapies. However, many of the new therapies - along with some of the older chemotherapeutic regimens such as anthracyclines - are potentially cardiotoxic, which is reflected increasingly frequently in the published literature. Cardiotoxicity adversely affects prognosis in cancer patients, thus its prevention and treatment are crucial to improve quality and standards of care. This review aims to explore the existing literature relating to chemotherapy- and radiotherapy-induced cardiotoxicity. An overview of the imaging modalities for the identification of cardiotoxicity and therapies for its prevention and management is also provided.
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Affiliation(s)
- Athanasios Koutsoukis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Alexandra Hospital Athens, Greece
| | - Argyrios Ntalianis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Alexandra Hospital Athens, Greece
| | - Evangelos Repasos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Alexandra Hospital Athens, Greece
| | - Efsthathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Alexandra Hospital Athens, Greece
| | | | - Ioannis Paraskevaidis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Alexandra Hospital Athens, Greece
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8
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Clark RA, Marin TS, Berry NM, Atherton JJ, Foote JW, Koczwara B. Cardiotoxicity and cardiovascular disease risk assessment for patients receiving breast cancer treatment. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2017; 3:6. [PMID: 32154001 PMCID: PMC7048103 DOI: 10.1186/s40959-017-0025-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/05/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cardiotoxicity from anticancer therapy affects heart function and structure. Cardiotoxicity can also lead to accelerated development of chronic diseases, especially in the presence of risk factors. METHODS This study aimed to develop and pilot a combined cardiovascular disease and cardiotoxicity risk assessment questionnaire to quantify the potential extent of risk factors in breast cancer patients prior to treatment. The questionnaire underwent content and face validity evaluation by an expert panel followed by pilot testing in a sample of breast cancer patients (n = 36). Questionnaires were self-administered while attending chemotherapy clinic, in the presence of a research assistant. RESULTS Mean age of participants was 54.8 years (range 36-72 years). Participants reported CVD risk factors including diabetes 2.8%, hypertension 19.8%, hypercholesterolaemia 11% and sleep apnoea 5%. Lifestyle risk factors, included not eating the recommended serves of vegetables (100%) or fruit (78%) per day; smoking (13%) and regularly consuming alcohol (75%). Twenty five percent reported being physically inactive, 61%, overweight or obese, 24%, little or no social support and 30% recorded high to very high psychological distress. Participants were highly (75%) reluctant to undertake lifestyle changes; i.e. changing alcohol consumption; dietary habits; good emotional/mental health strategies; improving physical activity; quitting smoking; learning about heart-health and weight loss. CONCLUSION This study is an important step towards prevention and management of treatment-associated cardiotoxicity after breast cancer diagnosis. We recommend that our questionnaire is providing important data that should be included in cancer registries so that researchers can establish the relationship between CVD risk profile and cardiotoxicity outcomes and that this study revealed important teaching opportunities that could be used to examine the impact on health literacy and help patients better understand the consequences of cancer treatment.
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Affiliation(s)
- Robyn A. Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Tania S. Marin
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Narelle M. Berry
- Norwich Medical School, University of East Anglia, James Watson Road, Norwich Research Park, Norwich, NR4 7UQ UK
| | - John J. Atherton
- Head Cardiology Royal Brisbane and Women’s Hospital, University of Queensland School of Medicine, Butterfield St & Bowen Bridge Rd, Herston, St Lucia, QLD Australia
| | - Jonathon W. Foote
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
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9
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Franzon J, Berry NM, Ullah S, Versace VL, McCarthy AL, Atherton J, Roder D, Koczwara B, Coghlan D, Clark RA. Heart failure following blood cancer therapy in pediatric and adult populations. Asia Pac J Clin Oncol 2017; 14:224-230. [PMID: 29024474 DOI: 10.1111/ajco.12782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/20/2017] [Indexed: 01/31/2023]
Abstract
AIM The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalized for heart failure. METHODS Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N = 23 434), 8339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. RESULTS Of those who were subsequently hospitalized for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. CONCLUSION The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population.
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Affiliation(s)
- Julie Franzon
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Narelle M Berry
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Shahid Ullah
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | | | - John Atherton
- Cardiology Department, Royal Brisbane and Women's Hospital and University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, Centre for Population Health Research, University of South Australia, Adelaide, Australia
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Douglas Coghlan
- Molecular Medicine and Pathology, Haematology, Flinders University, Adelaide, South Australia, Australia
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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10
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Tyrosine kinase-targeting drugs-associated heart failure. Br J Cancer 2017; 116:1366-1373. [PMID: 28399109 PMCID: PMC5482733 DOI: 10.1038/bjc.2017.88] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/17/2017] [Accepted: 02/23/2017] [Indexed: 02/02/2023] Open
Abstract
Background: The impact of cancer therapies on cardiac disease in the general adult cancer survivor population is largely unknown. Our objective was to evaluate which tyrosine kinase-targeting drugs are associated with greater risk for new-onset heart failure (HF). Methods: A nested case–control analysis was conducted within a cohort of 27 992 patients of Clalit Health Services, newly treated with a tyrosine kinase-targeting, and/or chemotherapeutic drug, for a malignant disease, between 1 January 2005 and 31 December 2012. Each new case of HF was matched to up to 30 controls from the cohort on calendar year of cohort entry, age, gender, and duration of follow-up. Main outcome measure was odds ratio (OR) with 95% confidence interval (CI) of new-onset HF. Results: There were 936 incident cases of HF during 71 742 person-years of follow-up. Trastuzumab (OR 1.90, 95% CI 1.46–2.49), cetuximab (OR 1.72, 1.10–2.69), panitumumab (OR 3.01, 1.02–8.85), and sunitinib (OR 3.39, 1.78–6.47) were associated with increased HF risk. Comorbidity independently associated with higher risk in a multivariable conditional regression model was diabetes mellitus, hypertension, chronic renal failure, ischaemic heart disease, valvular heart disease, arrhythmia, and smoking. Conclusions: Trastuzumab, cetuximab, panitumumab, and sunitinib are associated with increased risk for new-onset HF.
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