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Population-Based Long-term Cardiac-Specific Mortality Among Patients With Major Gastrointestinal Cancers
Daryl Ramai1, Joseph Heaton1, Michele Ghidini2
1Department of Internal Medicine, Brooklyn Hospital Center, Brooklyn, New York.
Insights
Patients with major gastrointestinal cancers face a high risk of cardiac mortality. Treatments including chemotherapy and radiation are linked to poorer survival outcomes from heart disease.
Area of Science:
- Oncology
- Cardiology
- Epidemiology
Background:
- Major gastrointestinal (GI) cancers pose a long-term risk for cardiac disease and mortality.
- Understanding cardiac-specific mortality in GI cancer patients is crucial for improving survival outcomes.
Purpose of the Study:
- To investigate cardiac-specific mortality rates in individuals with major GI cancers in the United States.
- To examine the association between radiation and chemotherapy and survival outcomes in this patient population.
Main Methods:
- A US cohort study analyzed individual patient data from 1990 to 2016 using the Surveillance, Epidemiology, and End Results (SEER) national cancer database.
- Included were over 359,000 patients diagnosed with colorectal, esophageal, gastric, pancreatic, or hepatocellular cancer.
- Cardiac-specific mortality was the primary outcome, with analyses considering various clinical and treatment factors.
Main Results:
- All major GI tumors were associated with an increased risk of cardiac mortality compared to noncardiac mortality.
- Hepatocellular cancer patients had the lowest cardiac-specific median survival time (98 months), followed by pancreatic, esophageal, gastric, and colorectal cancers.
- Use of chemotherapy, radiation, or combined therapy was associated with poorer survival rates from cardiac causes of death at 15 years.
Conclusions:
- Cardiac disease is a significant cause of mortality among patients with major gastrointestinal cancers.
- Adjuvant therapies, including chemotherapy and radiation, appear to be associated with increased cardiac mortality, warranting further investigation and potential interventions.
Importance:
Patients with major gastrointestinal (GI) cancers are at long-term risk for cardiac disease and mortality.
Objective:
To investigate the cardiac-specific mortality rate among individuals with major GI cancers and the association of radiation and chemotherapy with survival outcomes in the United States.
Design, Setting, And Participants:
This US cohort study included individual patient-level data of men and women older than 18 years with 5 major gastrointestinal cancers, including colorectal, esophageal, gastric, pancreatic, and hepatocellular cancer from 1990 to 2016. Data was extracted from the Surveillance, Epidemiology, and End Results (SEER) national cancer database. Data cleaning and analyses were conducted between November 2020 and March 2021.
Exposures:
Patients received chemotherapy, radiotherapy, or a combination of adjuvant therapy for major GI cancers.
Main Outcomes And Measures:
The primary outcome was cardiac-specific mortality. Examined factors associated with cardiac mortality included age, sex, race, tumor location, tumor grade, SEER stage, TNM (seventh edition) staging criteria, cancer treatment (ie, the use of radiation, chemotherapy, or surgery), survival months, and cause of death.
Results:
A total of 359 032 patients (mean [SD] age at baseline, 65.1 [12.9] years; 186 921 [52.1%] men) with GI cancers were analyzed, including 313 940 patients (87.4%) with colorectal cancer, 7613 patients (2.1%) with esophageal cancer, 21 048 patients (5.9%) with gastric cancer, 7227 patients (2.0%) with pancreatic cancer, and 9204 patients (2.6%) with hepatocellular cancer. Most cancers were localized except pancreatic cancer, which presented with regional and distant involvement (3680 cancers [50.9%]). Overall, all major gastrointestinal tumors were associated with increased risk of cardiac mortality compared with noncardiac mortality (median survival time: 121 [95% CI, 120-122] months vs 287 [95% CI, 284.44-290] months). Patients with hepatocellular cancer had the lowest cardiac-specific median survival time (98 [95% CI, 90-106] months), followed by pancreatic cancer (105 [95% CI, 98-112] months), esophageal cancer (113 [95% CI, 107-119] months), gastric cancer (113 [95% CI, 110-116] months), and colorectal cancer (122 [95% CI, 121-123] months). At 15 years of follow up, the use of only chemotherapy, only radiation, or radiation and chemotherapy combined was associated with poor survival rates from cardiac causes of death (eg, colorectal: chemotherapy, 0 patients; radiation, 1 patient [1.9%]; radiation and chemotherapy, 3 patients [2.7%]).
Conclusions And Relevance:
These findings suggest that among patients with major gastrointestinal cancers, cardiac disease is a significant cause of mortality. The use of only chemotherapy, only radiation, or both was associated with higher cardiac mortality.
