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Subramaniam S, Kong YC, Zaharah H, et al. Baseline cardiovascular comorbidities, and the influence on cancer treatment decision-making in women with breast cancer. Ecancermedicalscience. 2021;15:1293doi: 10.3332/ecancer.2021.1293.
Subramaniam, S., Kong, Y. C., Zaharah, H., Uiterwaal, C. S. P. M., Richard, A., Taib, N. A., Deniel, A., Chee, K. H., Bustamam, R. S., See, M. H., Fong, A., Yip, C. H., & Bhoo-Pathy, N. (2021). Baseline cardiovascular comorbidities, and the influence on cancer treatment decision-making in women with breast cancer. Ecancermedicalscience, 151293. https://doi.org/10.3332/ecancer.2021.1293
Subramaniam, Shridevi, et al. "Baseline cardiovascular comorbidities, and the influence on cancer treatment decision-making in women with breast cancer." Ecancermedicalscience vol. 15 (2021): 1293. doi: https://doi.org/10.3332/ecancer.2021.1293
Subramaniam S, Kong YC, Zaharah H, Uiterwaal CSPM, Richard A, Taib NA, Deniel A, Chee KH, Bustamam RS, See MH, Fong A, Yip CH, Bhoo-Pathy N. Baseline cardiovascular comorbidities, and the influence on cancer treatment decision-making in women with breast cancer. Ecancermedicalscience. 2021 Sep 21;15:1293. doi: 10.3332/ecancer.2021.1293. eCollection 2021. PMID: 34824616; PMCID: PMC8580595.
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Ecancermedicalscience. 2021 Sep 21;15:1293. doi: 10.3332/ecancer.2021.1293. eCollection 2021.

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

Ecancermedicalscience

Shridevi Subramaniam, Yek-Ching Kong, Hafizah Zaharah, Cuno S P M Uiterwaal, Andrea Richard, Nur Aishah Taib, Azura Deniel, Kok-Han Chee, Ros Suzanna Bustamam, Mee-Hoong See, Alan Fong, Cheng-Har Yip, Nirmala Bhoo-Pathy

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.

© the authors; licensee ecancermedicalscience.

Keywords: breast cancer; cardiotoxicity; cardiovascular risk factors

Conflict of interest statement

The authors have no conflict of interest to report.

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