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The recent development of numerous anti-cancer, immunotherapy and androgen deprivation drugs resulted in significant improvement in cancer survival. However, the cardiovascular toxicity of such drugs is not well known. Furthermore, radical resection surgeries can result in significant cardiac morbidity and mortality. Our aim is to investigate the cardiac death (CD) in cancer patients in the U.S.
National Cancer Institute, SEER. Stat (Surveillance, Epidemiology, and End Results) was queried to obtain records for all cancer patients 1998-2014(excluding skin cancer). SEER collects data from cancer registries covering approximately 34.6% of the U.S. population.
6,154,298 patients were included in the analysis (1998-2014), 2,980,693 patients (48.4%) died. Lung cancer was the leading COD, cardiac death (CD) was the 2nd with (4.8%) mortality rate. CD group analysis showed 59.5% were male, 40.5% Female. 82.7% White, 11.6% African-American. The incidence of CD was higher in patients >70 years old (7.2% vs. 5.4%) (P<0.001). The Most common site for primary cancer in the CD group was prostate 22.1%, colon 15.3%, breast12.2%, lung 9.6%, and urinary bladder 7.4%. 71.7% of the CD group had a Localized/regional disease; Surgery was performed in 53.4% of the CD group, including 24.7% radical surgery. Bladder cancer had the highest cardiac mortality (8.4%), while in prostate cancer, heart disease competes with Prostate cancer as leading COD (7.2% vs. 7.3%, respectively). Predictors of the CD on a multivariate regression model include male sex(P<0.001, 95% CI 1.16-1.4), advanced age at diagnosis(P<0.001, 95% CI 1.011-1.017), surgery was performed(P:0.01, 95% CI: 0.8-0.9), Lung and Breast as primary cancer sites. Advanced cancer stage was independent of the CD (P:0.48).
Heart disease is a major cause of morbidity and mortality in cancer patients. Candidates for aggressive radical surgeries or chemotherapies should be carefully selected in this aging cancer population. Our data suggest the need to continue to optimize the new evolving cardio-oncology service as a part of the multidisciplinary cancer care team. Further research needed to identify high-risk groups.
Poster Hall, Hall F
Sunday, March 17, 2019, 9:45 a.m.-10:30 a.m.
Session Title: Prevention: Clinical 3
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1232-434
- 2019 American College of Cardiology Foundation