Patient reported physical and mental health changes associated with a comprehensive cardiovascular risk reduction program for women with breast cancer receiving potentially cardiotoxic chemotherapy

Michael G Fradley,R Ashton Vautier,Roohi Ismail-Khan,Bernadette Shields,Marcus W Kilpatrick,Mohammed Alomar,Theresa M Beckie,Merna Armanious,Amey Best,Erika Bianco,Kevin Kip,Nhi Tran

doi:10.1186/s40959-021-00107-w

Abstract

ObjectiveWomen with breast cancer (BCA) and cardiovascular disease (CVD) risk factors are at increased risk of developing cardiovascular complications when exposed to potentially cardiotoxic cancer therapy. The benefit of aggressive CVD risk factor modification to reduce adverse treatment-related psychologic and biologic effects is not well established.MethodsUsing a single group pre-test, post-test design, 33 women with BCA receiving anthracycline and/or trastuzumab therapy participated in a 6-month comprehensive CVD risk reduction program involving formal cardio-oncology evaluation along with regular motivational counseling for improved nutrition and physical activity. Study parameters were assessed at baseline and 6 months with paired t-tests used to evaluate changes after the intervention.ResultsThe mental component summary score assessed by SF-36V2 improved significantly after program completion (45.0 to 48.8, effect size 0.37, p = 0.017), however the physical component summary score declined (46.2 to 40.9, effect size − 0.53, p = 0.004). Despite this decline in perceived physical health, markers of health-related fitness and nutritional status were maintained or improved. Systolic and diastolic blood pressure also improved after the intervention (136.7 to 124.1 mmHg, p = 0.001 and 84.0 to 78.7 mmHg, p = 0.031, respectively). No significant change in resting heart rate, body mass index, lipids, hemoglobin A1C, or left ventricular ejection fraction was observed.ConclusionsPatient-reported mental health improved significantly in women with BCA enrolled in a comprehensive CVD risk reduction program despite exposure to potentially cardiotoxic therapies. This study provides preliminary data for future randomized controlled trials evaluating the effects CVD risk reduction program in high-risk breast cancer cohorts.

Highlights

Breast cancer is the most common malignancy in women, accounting for 15% of new cancer cases, and almost 7% of cancer-related deaths [1]
Patient-reported mental health improved significantly in women with breast cancer (BCA) enrolled in a comprehensive cardiovascular disease (CVD) risk reduction program despite exposure to potentially cardiotoxic therapies
This study provides preliminary data for future randomized controlled trials evaluating the effects CVD risk reduction program in high-risk breast cancer cohorts

Summary

Introduction

Breast cancer is the most common malignancy in women, accounting for 15% of new cancer cases, and almost 7% of cancer-related deaths [1]. Postmenopausal women with breast cancer have higher cardiovascular disease (CVD) mortality than women without breast cancer; a risk that manifests around 7 years after cancer diagnosis [3]. Women with breast cancer (BCA) are at increased risk of developing CVD complications when exposed to treatment regimens consisting of anthracyclines, HER2 targeted agents such as trastuzumab, and/or left sided breast radiation [4]. In 2018, the American Heart Association (AHA) published its first scientific statement on CVD and breast cancer in an effort to increase awareness of the problem and highlight the need for proper CV prevention in this patient population [6]. Our study aimed to prospectively examine the psychosocial and physical benefits of a structured program for CVD risk monitoring and modification for high risk breast cancer patients receiving potentially cardiotoxic cancer therapy

Methods

Results

Conclusion