Stroke among cancer patients

Nicholas G Zaorsky,Heath B Mackley,Brad E Zacharia,Leila T Tchelebi,Ying Zhang,Vernon M Chinchilli

doi:10.1038/s41467-019-13120-6

Nicholas G Zaorsky, Heath B Mackley + Show 4 more

Open Access

https://doi.org/10.1038/s41467-019-13120-6

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Abstract

We identify cancer patients at highest risk of fatal stroke. This is a population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results program, 1992-2015. Among 7,529,481 cancer patients, 80,513 died of fatal stroke (with 262,461 person-years at risk); the rate of fatal stroke was 21.64 per 100,000-person years, and the standardized mortality ratio (SMR) of fatal stroke was 2.17 (95% CI, 2.15, 2.19). Patients with cancer of the prostate, breast, and colorectum contribute to the plurality of cancer patients dying of fatal stroke. Brain and gastrointestinal cancer patients had the highest SMRs (>2-5) through the follow up period. Among those diagnosed at <40 years of age, the plurality of strokes occurs in patients treated for brain tumors and lymphomas; if >40, from cancers of the prostate, breast, and colorectum. For almost all cancers survivors, the risk of stroke increases with time.

Highlights

We identify cancer patients at highest risk of fatal stroke
The rate of stroke per 100,000-person-years was 21.64, and the standardized mortality ratio (SMR) of stroke was 2.17
Patients who were diagnosed at a younger age had a higher SMR for stroke, and the SMRs gradually declined as patients were diagnosed at a later age; those 80-year-olds had an SMR of 1.84

Summary

Introduction

We identify cancer patients at highest risk of fatal stroke. This is a population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results program, 1992-2015. Brain and gastrointestinal cancer patients had the highest SMRs (>2-5) through the follow up period Among those diagnosed at 40, from cancers of the prostate, breast, and colorectum. As the survival rates of cancer patients continue to increase, it will become crucial to identify cancer survivors at elevated risk of stroke. There is currently no resource to assist clinicians, including primary care physicians, oncologists, neurologists, neurosurgeons, and cardiologists, in identifying cancer patients at highest risk of stroke. This work may be used clinically by physicians in the creation of survivorship programs to mitigate the risk of stroke among cancer patients

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