Higher risk of cardiovascular mortality than cancer mortality among long-term cancer survivors

Abstract

BackgroundPrevious studies focused more on the short-term risk of cardiovascular (CV) death due to traumatic psychological stress after a cancer diagnosis and the acute cardiotoxicity of anticancer treatments than on the long-term risk of CV death.MethodsTime trends in the proportions of CV death (PCV), cancer death (PCA), and other causes in deaths from all causes were used to show preliminary relationships among the three causes of death in 4,806,064 patients with cancer from the Surveillance, Epidemiology, and End Results (SEER) program. Competing mortality risk curves were used to investigate when the cumulative CV mortality rate (CMRCV) began to outweigh the cumulative cancer mortality rate (CMRCA) for patients with cancer who survived for more than 10 years. Multivariable competing risk models were further used to investigate the potential factors associated with CV death.ResultsFor patients with cancer at all sites, the PCV increased from 22.8% in the 5th year after diagnosis to 31.0% in the 10th year and 35.7% in the 20th year, while the PCA decreased from 57.7% in the 5th year after diagnosis to 41.2 and 29.9% in the 10th year and 20th year, respectively. The PCV outweighed the PCA (34.6% vs. 34.1%) since the 15th year for patients with cancer at all sites, as early as the 9th year for patients with colorectal cancer (37.5% vs. 33.2%) and as late as the 22nd year for patients with breast cancer (33.5% vs. 30.6%). The CMRCV outweighed the CMRCA since the 25th year from diagnosis. Multivariate competing risk models showed that an increased risk of CV death was independently associated with older age at diagnosis [hazard ratio and 95% confidence intervals [HR (95%CI)] of 43.39 (21.33, 88.28) for ≥ 80 vs. ≤ 30 years] and local metastasis [1.07 (1.04, 1.10)] and a decreased risk among women [0.82 (0.76, 0.88)], surgery [0.90 (0.87, 0.94)], and chemotherapy [0.85 (0.81, 0.90)] among patients with cancer who survived for more than 10 years. Further analyses of patients with cancer who survived for more than 20 years and sensitivity analyses by cancer at all sites showed similar results.ConclusionCV death gradually outweighs cancer death as survival time increases for most patients with cancer. Both the cardio-oncologist and cardio-oncology care should be involved to reduce CV deaths in long-term cancer survivors.

Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study

“…The reason for the higher SMR in the elderly group may be attributed to their poorer health, reduced immunity, and increased prevalence of comorbidities, including infections. [ 49 , 50 ] Furthermore, out of the 6 cardiovascular disease-related causes of death, patients with HCC exhibited the highest SMR for hypertension. This finding could potentially be attributed to the use of HCC-related drugs such as bevacizumab, ramucirumab, sorafenib, and sunitinib, [ 51 ] all of which have been associated with an elevated risk of hypertension in patients with HCC.…”

Cardio-oncology rehabilitation: are we ready?

“…Cardiovascular disease (CVD) and cancer are competing causes of mortality in cancer patients. 1 Multiple shared risk factors coupled to cancer therapy-induced metabolic derangements and cardiovascular (CV) toxicities increase the probability of the coexistence of the two diseases. 2 Cancer patients should be considered ‘survivors’ ever since the diagnosis of cancer, a crucial moment that marks the beginning of a proactive preventive process that should last for the whole life.…”

Novel insights into cardiovascular toxicity of cancer targeted and immune therapies: Beyond ischemia with non-obstructive coronary arteries (INOCA)

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