Omar Abdel-Rahman1, Yuan Xu2, Shiying Kong2, Joseph Dort3, May Lynn Quan3, Safiya Karim4, Antoine Bouchard-Fortier3, HyoKeun Cho4, Winson Y Cheung5. 1. Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada. 2. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 3. Department of Surgery, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada. 4. Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada. 5. Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada. Electronic address: winson.cheung@ahs.ca.
Abstract
INTRODUCTION: The aim of this study was to characterize treatment trends and outcomes of women who have preexisting cardiovascular disease (CVD) prior to the diagnosis of breast cancer. PATIENTS AND METHODS: This represented a retrospective, population-based cohort study that analyzed pooled data from the provincial cancer registry, physician billing claims, hospital discharge abstracts, ambulatory care, and the 2011 census in a large Canadian province. Multivariable logistic regression was performed to identify the associations of CVD with breast cancer treatment and outcomes. Kaplan-Meier analyses were conducted and survival was compared between CVD and non-CVD groups. Cox regression models were constructed to determine the effect of CVD on overall and cancer-specific survival. RESULTS: A total of 25,594 women with breast cancer were eligible and included in the current analysis. Preexisting CVD was associated with a lower likelihood of receiving chemotherapy (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.48-0.66; P < .0001) and radiotherapy (OR, 0.75; 95% CI, 0.67-0.83; P < .0001), but a higher probability of undergoing mastectomy (OR, 1.13; 95% CI, 1.03-1.25; P = .011). Unadjusted Kaplan-Meier analyses showed that individuals with preexisting CVD experienced worse median overall and cancer-specific survival when compared with those without CVD (87 vs. 150 months and 106 vs. 131 months, respectively; both P < .0001). Adjusting for measured confounders, the presence of preexisting CVD continued to predict for worse overall survival (hazard ratio, 1.55; 95% CI, 1.43-1.67; P < .0001), but not cancer-specific survival (hazard ratio, 1.11; 95% CI, 0.98-1.27; P = .099). CONCLUSIONS: Patients with breast cancer with preexisting CVD are less likely to receive recommended treatment for their cancer and more likely to exhibit worse overall survival.
INTRODUCTION: The aim of this study was to characterize treatment trends and outcomes of women who have preexisting cardiovascular disease (CVD) prior to the diagnosis of breast cancer. PATIENTS AND METHODS: This represented a retrospective, population-based cohort study that analyzed pooled data from the provincial cancer registry, physician billing claims, hospital discharge abstracts, ambulatory care, and the 2011 census in a large Canadian province. Multivariable logistic regression was performed to identify the associations of CVD with breast cancer treatment and outcomes. Kaplan-Meier analyses were conducted and survival was compared between CVD and non-CVD groups. Cox regression models were constructed to determine the effect of CVD on overall and cancer-specific survival. RESULTS: A total of 25,594 women with breast cancer were eligible and included in the current analysis. Preexisting CVD was associated with a lower likelihood of receiving chemotherapy (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.48-0.66; P < .0001) and radiotherapy (OR, 0.75; 95% CI, 0.67-0.83; P < .0001), but a higher probability of undergoing mastectomy (OR, 1.13; 95% CI, 1.03-1.25; P = .011). Unadjusted Kaplan-Meier analyses showed that individuals with preexisting CVD experienced worse median overall and cancer-specific survival when compared with those without CVD (87 vs. 150 months and 106 vs. 131 months, respectively; both P < .0001). Adjusting for measured confounders, the presence of preexisting CVD continued to predict for worse overall survival (hazard ratio, 1.55; 95% CI, 1.43-1.67; P < .0001), but not cancer-specific survival (hazard ratio, 1.11; 95% CI, 0.98-1.27; P = .099). CONCLUSIONS:Patients with breast cancer with preexisting CVD are less likely to receive recommended treatment for their cancer and more likely to exhibit worse overall survival.
Authors: Ursula Berger; Melina Arnold; Mirjam Kohls; Heinz Freisling; Hadrien Charvat; Isabelle Soerjomataram; Vivian Viallon; Veronica Davila-Batista; Rudolf Kaaks; Renée Turzanski-Fortner; Krasimira Aleksandrova; Matthias B Schulze; Christina C Dahm; Helene Tilma Vistisen; Agnetha Linn Rostgaard-Hansen; Anne Tjønneland; Catalina Bonet; Maria-Jose Sánchez; Sandra Colorado-Yohar; Giovanna Masala; Domenico Palli; Vittorio Krogh; Fulvio Ricceri; Olov Rolandsson; Sai San Moon Lu; Konstantinos K Tsilidis; Elisabete Weiderpass; Marc J Gunter; Pietro Ferrari Journal: BMC Cancer Date: 2022-05-14 Impact factor: 4.638