Baseline cardiovascular comorbidities, and the influence on cancer treatment decision-making in women with breast cancer

Shridevi Subramaniam^{1

2}, Yek-Ching Kong^{1

3}, Hafizah Zaharah⁴, Cuno S P M Uiterwaal⁵, Andrea Richard², Nur Aishah Taib⁶, Azura Deniel⁷, Kok-Han Chee⁸, Ros Suzanna Bustamam⁷, Mee-Hoong See⁶, Alan Fong⁹, Cheng-Har Yip¹⁰, Nirmala Bhoo-Pathy^{1

3}

Affiliations

¹ Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
² Centre of Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Setia Alam, 40170 Shah Alam, Malaysia.
³ Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
⁴ Department of Radiotherapy & Oncology, National Cancer Institute, 62250 Putrajaya, Malaysia.
⁵ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
⁶ Department of Surgery, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
⁷ Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, 50586 Kuala Lumpur, Malaysia.
⁸ Cardiology Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
⁹ Sarawak Heart Centre, 94300 Kota Samarahan, Sarawak, Malaysia.
¹⁰ Subang Jaya Medical Centre, 47500 Subang Jaya, Selangor, Malaysia.

PMID: 34824616
PMCID: PMC8580595
DOI: 10.3332/ecancer.2021.1293

Baseline cardiovascular comorbidities, and the influence on cancer treatment decision-making in women with breast cancer

Shridevi Subramaniam et al. Ecancermedicalscience. 2021.

. 2021 Sep 21:15:1293.

doi: 10.3332/ecancer.2021.1293. eCollection 2021.

Authors

Affiliations

¹ Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
² Centre of Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Setia Alam, 40170 Shah Alam, Malaysia.
³ Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
⁴ Department of Radiotherapy & Oncology, National Cancer Institute, 62250 Putrajaya, Malaysia.
⁵ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
⁶ Department of Surgery, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
⁷ Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, 50586 Kuala Lumpur, Malaysia.
⁸ Cardiology Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
⁹ Sarawak Heart Centre, 94300 Kota Samarahan, Sarawak, Malaysia.
¹⁰ Subang Jaya Medical Centre, 47500 Subang Jaya, Selangor, Malaysia.

PMID: 34824616
PMCID: PMC8580595
DOI: 10.3332/ecancer.2021.1293

Abstract

Purpose: To measure the baseline prevalence of cardiovascular disease (CVD), its modifiable and non-modifiable risk factors in breast cancer patients, and determine their association with adjuvant treatment decision-making.

Method: From 2016 to 2017, 2,127 women newly-diagnosed with breast cancer were prospectively recruited. Participants' cardiovascular biomarkers were measured prior to adjuvant treatment decision-making. Clinical data and medical histories were obtained from hospital records. Adjuvant treatment decisions were collated 6-8 months after recruitment. A priori risk of cardiotoxicity was predicted using the Cardiotoxicity Risk Score.

Results: Mean age was 54 years. Eighty-five patients had pre-existing cardiac diseases and 30 had prior stroke. Baseline prevalence of hypertension was 47.8%. Close to 20% had diabetes mellitus, or were obese. Dyslipidaemia was present in 65.3%. The proportion of women presenting with ≥2 modifiable CVD risk factors at initial cancer diagnosis was substantial, irrespective of age. Significant ethnic variations were observed. Multivariable analyses showed that pre-existing CVD was consistently associated with lower administration of adjuvant breast cancer therapies (odds ratio for chemotherapy: 0.32, 95% confidence interval: 0.17-0.58). However, presence of multiple risk factors of CVD did not appear to influence adjuvant treatment decision-making. In this study, 63.6% of patients were predicted to have high risks of developing cardiotoxicities attributed to a high baseline burden of CVD risk factors and anthracycline administration.

Conclusion: While recent guidelines recommend routine assessment of cardiovascular comorbidities in cancer patients prior to initiation of anticancer therapies, this study highlights the prevailing gap in knowledge on how such data may be used to optimise cancer treatment decision-making.

Keywords: breast cancer; cardiotoxicity; cardiovascular risk factors.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflict of interest to report.

Cited by

Association of pre-existing cardiovascular disease with administration of fluoropyrimidine chemotherapy in patients with gastrointestinal malignancies.
Abiodun AT, Ju C, Welch CA, Lai J, Tyrer F, Chambers P, Paley L, Vernon S, Deanfield J, de Belder M, Rutherford M, Lambert PC, Slater S, Shiu KK, Wei L, Peake MD; VICORI collaborative; Adlam D, Manisty C. Abiodun AT, et al. BMJ Oncol. 2024 Aug 8;3(1):e000323. doi: 10.1136/bmjonc-2024-000323. eCollection 2024. BMJ Oncol. 2024. PMID: 39886129 Free PMC article.
The Association Between Medication Use in Older Women with Early-Stage Operable Primary Breast Cancer and Decision Regarding Primary Treatment.
Tse N, Parks RM, Holmes HM, Cheung KL. Tse N, et al. Oncologist. 2023 Mar 17;28(3):e128-e135. doi: 10.1093/oncolo/oyac278. Oncologist. 2023. PMID: 36718086 Free PMC article.
Association between pre-existing cardiometabolic comorbidities and the pathological profiles of breast cancer at initial diagnosis: a cross sectional study.
Subramaniam S, Kong YC, Yip CH, Thiagarajan M, Pailoor J, Zaharah H, Taib NA, See MH, Sarfati D, Bhoo-Pathy N. Subramaniam S, et al. Ecancermedicalscience. 2023 Feb 23;17:1512. doi: 10.3332/ecancer.2022.1512. eCollection 2023. Ecancermedicalscience. 2023. PMID: 37113731 Free PMC article.
Association Between Adherence to Clinical Practice Guidelines for Adjuvant Therapy for Breast Cancer and Survival in a Resource-Limited Setting.
Song CV, Yip CH, Mohd Taib NA, See MH, Teoh LY, Monninkhof EM, Saad M, Uiterwaal CSPM, Bhoo-Pathy N. Song CV, et al. JCO Glob Oncol. 2022 Mar;8:e2100314. doi: 10.1200/GO.21.00314. JCO Glob Oncol. 2022. PMID: 35245099 Free PMC article.
NLRP3-mediated inflammation in cardio-oncology: sterile yet harmful.
Mauro AG, Mezzaroma E, Toldo S, Melendez GC, Franco RL, Lesnefsky EJ, Abbate A, Hundley WG, Salloum FN. Mauro AG, et al. Transl Res. 2023 Feb;252:9-20. doi: 10.1016/j.trsl.2022.08.004. Epub 2022 Aug 7. Transl Res. 2023. PMID: 35948198 Free PMC article. Review.

See all "Cited by" articles

References

1. Zaorsky NG, Churilla TM, Egleston BL, et al. Causes of death among cancer patients. Ann Oncol. 2017;28:400–407. doi: 10.1093/annonc/mdw604. - DOI - PMC - PubMed
1. Khouri MG, Douglas PS, Mackey JR, et al. Cancer therapy-induced cardiac toxicity in early breast cancer: addressing the unresolved issues. Circulation. 2012;126:2749–2763. doi: 10.1161/CIRCULATIONAHA.112.100560. - DOI - PMC - PubMed
1. Thavendiranathan P, Abdel-Qadir H, Fischer HD, et al. Breast cancer therapy-related cardiac dysfunction in adult women treated in routine clinical practice: a population-based cohort study. J Clin Oncol. 2016;34:2239–2246. doi: 10.1200/JCO.2015.65.1505. - DOI - PubMed
1. Blaes AH, Thavendiranathan P, Moslehi J. Cardiac toxicities in the era of precision medicine: underlying risk factors, targeted therapies, and cardiac biomarkers. Am Soc Clinl Oncol Educ Book. 2018;38:764–774. doi: 10.1200/EDBK_208509. - DOI - PubMed
1. Hooning MJ, Botma A, Aleman BMP, et al. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst. 2007;99:365–375. doi: 10.1093/jnci/djk064. - DOI - PubMed

LinkOut - more resources

Full Text Sources
- Europe PubMed Central
- PubMed Central
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Baseline cardiovascular comorbidities, and the influence on cancer treatment decision-making in women with breast cancer

Affiliations

Baseline cardiovascular comorbidities, and the influence on cancer treatment decision-making in women with breast cancer

Authors

Affiliations

Abstract

Conflict of interest statement

Similar articles

Cited by

References

LinkOut - more resources

Full Text Sources

Miscellaneous