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Prognostic impact of coexisting cardiovascular disease in patients with cancer: A multicenter retrospective cohort
Yoshihiro Kuwabara1, Toshitaka Morishima1, Haruka Kudo1
1Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
Insights
Cardiovascular disease (CVD) at cancer diagnosis significantly impacts survival. Heart failure (HF) severity, particularly advanced stages, further worsens prognosis for cancer patients, highlighting the need for integrated care.
Area of Science:
- Oncology
- Cardiology
- Public Health
Background:
- Global rise in cancer and cardiovascular disease (CVD) incidence.
- Unclear impact of coexisting CVD on cancer patient survival.
- Need to understand CVD's influence on cancer prognosis.
Purpose of the Study:
- To investigate the effect of coexisting CVD on overall survival in cancer patients.
- To analyze the impact of specific CVD subtypes, especially heart failure (HF) severity, on cancer survival.
Main Methods:
- Utilized cancer registries and administrative claims data from 36 Japanese cancer care hospitals (2010-2015).
- Included 131,701 cancer patients, with 9704 having coexisting CVD.
- Employed Cox proportional hazard models to assess survival and HF severity (NYHA classification).
Main Results:
- Patients with coexisting CVD had lower 3-year survival rates (62.9%) compared to those without (77.6%).
- Coexisting CVD increased all-cause mortality risk (aHR 1.47).
- Heart failure (HF) showed the poorest prognosis, with NYHA Class IV HF patients having the highest mortality risk (aHR 2.47).
Conclusions:
- Coexisting cardiovascular disease (CVD) at cancer diagnosis is linked to reduced survival.
- Heart failure (HF) severity, categorized by NYHA classification, significantly predicts survival outcomes in cancer patients.
Background:
The incidence of malignancy and cardiovascular disease (CVD) is increasing worldwide. However, it is not entirely clear how the coexistence of CVD at the time of cancer diagnosis affects the overall survival of patients with cancer.
Methods And Results:
We used the cancer registries and administrative claims data of patients diagnosed with cancer at 36 designated cancer care hospitals in Osaka, Japan, from 2010 to 2015. The Cox proportional hazard model was used to examine how coexisting CVD (heart failure [HF], ischemic heart disease, peripheral arterial disease, cerebrovascular accidents, and atrial fibrillation) affected overall survival and the impact of HF severity, as documented by the New York Heart Association (NYHA) classification. Of the 131,701 patients with cancer, 9704 had coexisting CVD. The 3-year survival rates for patients with and without coexisting CVD were 62.9 % and 77.6 %, respectively. The adjusted hazard ratio (aHR) for all-cause mortality for coexisting CVD was 1.47 (95 % confidence interval, 1.41-1.52). Among the CVD subtype, patients with coexisting HF had the poorest prognosis. The aHRs in patients with HF by NYHA classification, using the patients without HF as a reference, were as follows: Class I: 1.33 (p = 0.217); II: 1.68 (p < 0.001); III: 1.54 (p = 0.011); IV: 2.47 (p < 0.001).
Conclusion:
Coexisting CVD and HF severity at cancer diagnosis is associated with survival in patients with cancer.
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