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Survival of cancer patients with pre-existing heart disease
Ciaran O'Neill1,2, David W Donnelly3, Mark Harbinson4
1Northern Ireland Cancer Registry, Belfast, UK. ciaran.oneill@qub.ac.uk.
Insights
Cancer patients with pre-existing cardiovascular diseases have poorer survival rates. This highlights how comorbidities like heart conditions may contribute to lower national cancer survival statistics.
Area of Science:
- Oncology
- Cardiology
- Public Health
Background:
- Cancer outcomes in Northern Ireland lag behind other developed nations.
- Comorbidities are a suspected factor, but data limitations have hindered research.
- This study utilizes single-jurisdiction data to overcome comparability issues.
Purpose of the Study:
- To investigate the association between pre-existing cardiovascular diseases and mortality in cancer patients.
- To analyze all-cause and cancer-specific mortality in relation to cardiovascular comorbidities.
- To inform strategies for improving cancer patient outcomes in Northern Ireland.
Main Methods:
- Utilized data from the Northern Ireland Cancer Registry (NICR) for cancer diagnoses (2011-2014).
- Linked cancer registry data with hospital discharge records to identify pre-existing cardiovascular diseases (ICD10 codes).
- Employed descriptive statistics and Cox proportional hazards regression, controlling for age, deprivation, stage, and other comorbidities.
Main Results:
- Nearly 23% of ~35,000 cancer patients had a prior cardiovascular condition.
- A pre-existing cardiovascular disease increased the hazard ratio for death by 1.28 (95% CI: 1.18-1.40).
- Higher all-cause and cancer-specific mortality was observed across lung, breast, prostate, and colorectal cancers in patients with cardiovascular diseases.
Conclusions:
- Pre-existing cardiovascular diseases are linked to poorer outcomes in cancer patients.
- The high prevalence of cardiovascular disease may negatively impact national cancer survival rates.
- Addressing cardiovascular comorbidities is crucial for improving cancer care and outcomes.
Background:
While cancer outcomes have improved over time, in Northern Ireland they continue to lag behind those of many other developed economies. The role of comorbid conditions has been suggested as a potential contributory factor in this but issues of data comparability across jurisdictions has inhibited efforts to explore relationships. We use data from a single jurisdiction of the UK using data from - the Northern Ireland Cancer Registry (NICR), to examine the association between mortality (all-cause and cancer specific) and pre-existing cardiovascular diseases among patients with cancer.
Materials And Methods:
All patients diagnosed with cancer (excluding non-melanoma skin cancer) between 2011 and 2014 were identified from Registry records. Those with a pre-existing diagnosis of cardiovascular diseases were identified by record linkage with patient hospital discharge data using ICD10 codes. Survival following diagnosis was examined using descriptive statistics and Cox proportional hazards regression analyses. Analyses examined all-cause mortality and cancer specific mortality for lung, colorectal, breast and prostate cancer. As well as cardiovascular diseases, regression models controlled for age, gender (where appropriate), deprivation (as quintiles), stage at diagnosis and other comorbidities.
Results:
Almost 35,000 incident cancer cases were diagnosed during the study period of which approximately 23% had a prior heart condition. The pan-cancer hazard ratio for death in the presence of pre-existing cardiovascular diseases was 1.28 (95% CI: 1.18-1.40). All-cause and cancer specific mortality was higher for patients with cardiovascular diseases across lung, female breast, prostate and colorectal cancer groups after controlling for age, gender (where appropriate), deprivation (as quintiles), stage at diagnosis and other comorbidities.
Conclusion:
Pre-existing morbidity may restrict the treatment of cancer for many patients. In this cohort, cancer patients with pre-existing cardiovascular diseases had poorer outcomes than those without cardiovascular diseases. A high prevalence of cardiovascular diseases may contribute to poorer cancer outcomes at a national level.
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