Heart Disease Mortality After Primary Cancer Surgery in the United States

Patients with cancer may be at higher risk of heart disease from anticancer therapies. However, there is limited data on the risks of heart disease mortality after primary cancer site surgery. This study sought to evaluate the incidence, timing, and risk factors of heart disease mortality after primary cancer site surgery.

The Surveillance, Epidemiology, and End Results (SEER) database was used to perform a retrospective population-based study of cancer patients who underwent primary surgical resection from 2000 to 2020. The incidence of heart disease mortality after primary cancer site surgery was described by standardized mortality ratios (SMRs) and the timing of heart disease mortality after surgery was characterized. Risk factors were identified using Fine and Gray competing risk analysis.

Among the 1,390,585 cancer patients who underwent primary surgical resection from 2000 to 2020, 178,303 (12.8%) died of heart disease. The SMR of heart disease death after surgery was 6.85 (95% CI: 6.82-6.88, P <0.001). SMRs were highest in cancers of the brain and other nervous system, esophagus, liver and intrahepatic bile duct, pancreas, and lung and bronchus. Approximately 50% of all heart disease deaths occurred within the first 5 years after surgery for all cancers. Risk factors included older age, male sex, Black race, unmarried status, and rurality.

The incidence of death from heart disease was significantly elevated in patients who underwent primary cancer site surgery compared with the general US population. These findings can be used to guide surgical planning and follow-up strategies.