Impact of preexisting cardiovascular disease (CVD) on treatments and outcomes of patients with breast or lung cancer.

Abstract

12063 Background: Prior cardio-oncology and geriatric oncology research has mainly focused on cancer treatments and their late effects on cardiac health, but little information is known about how cardiac health may influence subsequent cancer treatments. This real-world study aimed to evaluate the associations of pre-existing CVD on treatment adherence and survival in patients with breast or lung cancer. Methods: We linked administrative data from the population-based cancer registry, electronic medical records, and billing claims in a large province (Alberta, Canada) over a 10-year time period (2006-2015). Multivariable logistic regression analyses were performed to identify associations of CVD with cancer treatments. Multivariable Cox proportional hazards models were constructed to determine the effect of CVD on overall survival (OS), while adjusting for receipt of cancer treatments. Results: We identified 46,227 patients with breast or lung cancer, of whom 77% were women and median age was 65 years. While 82% of patients with breast cancer were early stage, 50% with lung cancer had metastasis. The prevalence of pre-existing CVD was 20% where congestive heart failure was most frequent. In logistic regression, CVD was associated with lower odds of receiving appropriate chemotherapy (OR, 0.60, 95% CI, 0.56-0.65, P<.0001), radiotherapy (OR, 0.76, 95% CI, 0.72-0.81, P<.0001), and surgery (OR, 0.60, 95% CI, 0.54-0.66, P <.0001), irrespective of tumor site (Table). The 5-year OS was lower in patients with baseline CVD as compared to those without (46% vs 58%, P<0.0001). Upon adjusting for stage and treatment, CVD continued to correlate with worse OS (HR, 1.23, 95% CI, 1.19-1.26; P<.0001). Conclusions: Cancer patients with prior CVD were less likely to receive standard cancer therapy. Even among those who underwent cancer treatments, worse outcomes were observed in those with CVD. Early cardio-oncology and geriatric oncology engagement may reduce treatment bias and ensure that carefully selected patients with a cardiac history are still offered appropriate cancer therapy. [Table: see text]