Abstract
PurposeTo 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.MethodFrom 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.ResultsMean 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.ConclusionWhile 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.
Highlights
Multivariable analyses showed that pre-existing Cardiovascular disease (CVD) was consistently associated with lower administration of adjuvant breast cancer therapies
Routine screening for conventional risk factors of CVD at initial cancer diagnosis had been lacking in oncology practices worldwide [9] despite its potential to facilitate cardiovascular profiling, adjuvant treatment decision-making and identification of high-risk patients requiring early cardiology referral and close monitoring [11]
While many professional guidelines including those from the American Society of Clinical Oncology [12] and the European Society of Medical Oncology [26] have recommended routine cardiovascular evaluation of adult patients with cancer prior to initiation of potentially cardiotoxic therapies, the present findings allude to a gap in knowledge on whether data on burden of traditional cardiovascular risk factors may be useful in optimisation of cancer treatment decision-making
Summary
Cardiovascular disease (CVD) is emerging to rival cancer recurrence as a leading cause of death in women with early breast cancer [1].The increased risk of morbidity and mortality from CVD in women with breast cancer may be attributed to a combination of the direct cardiotoxic effects (e.g. anthracycline-based chemotherapy, trastuzumab, radiotherapy) and the indirect effects (e.g. weight gain, loss of cardiorespiratory fitness) of cancer therapy, coupled with clustering of conventional risk factors of CVD including hypertension, diabetes mellitus, dyslipidaemia, obesity and smoking [2,3,4,5,6,7,8].Until very recently, guidelines for cardiovascular risk assessment in adults with cancer had been scarce [9,10]. Routine screening for conventional risk factors of CVD at initial cancer diagnosis had been lacking in oncology practices worldwide [9] despite its potential to facilitate cardiovascular profiling, adjuvant treatment decision-making and identification of high-risk patients requiring early cardiology referral and close monitoring [11]. This guideline recommends physicians to perform comprehensive cardiovascular evaluation in adult patients with cancer including screening for modifiable risk factors of CVD before initiation of potentially cardiotoxic therapies [12,13]. Amidst the lack of evidence-based standards, we assessed whether the baseline presence of CVD or presence of multiple risk factors of CVD was associated with adjuvant treatment administration, to gain an insight on whether these factors currently influenced cancer treatment decision-making in routine clinical practice. A priori risk of cardiotoxicity following adjuvant therapy was predicted
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
