Determinants of newly diagnosed comorbidities among breast cancer survivors

Obi, Nadia; Gornyk, Daniela; Heinz, Judith; Vrieling, Alina; Seibold, Petra; Chang‐Claude, Jenny; Flesch-Janys, Dieter

doi:10.1007/s11764-013-0338-y

Cited by 21 publications

(25 citation statements)

References 40 publications

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“…The explanation underlying the increased risk of cancer in stroke survivors in all age groups is not fully known. A relatively high prevalence of preexisting or incident cardiovascular disease and risk factors has been recognized in patients with cancer [18,19,20,21]. There may not be a cause-and-effect relationship between the two disease processes.…”

Section: Discussionmentioning

confidence: 99%

Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients

et al. 2015

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Background: Subclinical cancer can manifest as a thromboembolic event and may be detected at a later interval in ischemic stroke survivors. We determined the rate of incident cancer and effect on cardiovascular endpoints in a large cohort of ischemic stroke survivors. Methods: An analysis of 3,680 adults with nondisabling cerebral infarction who were followed for two years within the randomized, double-blinded VISP trial was performed. The primary intervention was best medical/surgical management plus a daily supplementation of vitamin B6, vitamin B12, and folic acid. We calculated age-adjusted rates of incidence of cancer among ischemic stroke survivors and standardized incidence ratios (SIR) with 95% confidence intervals (CI) based on comparison with age-adjusted rates in the general population. The significant variables from univariate analysis were entered in a Cox Proportional Hazards analysis to identify the association between various baseline factors and incident cancer after adjusting age, gender, and race/ethnicity. A logistic regression analysis evaluated the association between incident cancer and various endpoints including stroke, coronary heart disease, myocardial infarction, and death after adjusting age, gender, and race/ethnicity. Results: A total of 3,247 patients (mean age ± SD of 66 ± 11; 2,013 were men) were cancer free at the time of enrollment. The incidence of new cancer was 0.15, 0.80, 1.2, and 2.0 per 100 patients at 1 month, 6 months, 1 year, and 2 years, respectively. The age-adjusted annual rate of cancer in patients with ischemic stroke was higher than in persons in the general population at 1 year (581.8/100,000 persons vs. 486.5/100,000 persons, SIR 1.2, 95% CI 1.16-1.24) and 2 years (1,301.7/100,000 vs. 911.5/100,000, SIR 1.4, 95% CI 1.2-1.6) after recruitment. There was a higher risk for death (odds ratio (OR) 3.1, 95% CI 1.8-5.4), and composite endpoint of stroke, coronary heart disease, and/or death (OR 1.4, 95% CI 1.0-2.2) among participants who developed incident cancer compared with those who were cancer free after adjusting for potential confounders. Conclusions: The annual rate of age-adjusted cancer incidence was higher among ischemic stroke patients compared with those in the general population. The odds of mortality were three folds higher among stroke survivors who developed incident cancer.

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Section: Discussionmentioning

confidence: 99%

Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients

et al. 2015

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“…Another important factor is the combination of glucocorticoids and antiemetics used to minimize the side effects of CTx agents 8,11 . Psychological stress-related emotional volatility and start of menopause may also be related to weight gain during CTx 12 . Interruption of ovarian function reduces metabolism, muscle mass, and energy expended, and also stimulates fat accumulation [13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Variations in the body mass index in Brazilian women undergoing adjuvant chemotherapy for breast cancer

Ricci

Formigoni

Zuliani

et al. 2014

Rev. Bras. Ginecol. Obstet.

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PURPOSE: To evaluate variations in the body mass index in patients undergoing adjuvant chemotherapy for breast cancer, and to associate these changes with patient's age and adjuvant chemotherapy regimen. METHODS: We performed a retrospective cohort study in order to correlate any variation in the body mass index before and after adjuvant chemotherapy with patient's age and adjuvant chemotherapy regimen. Patients who received any form of prior hormone therapy, such as tamoxifen or aromatase inhibitors, were excluded. We selected data for 196 patients with stage I to III breast cancer who were treated by radical or conservative surgery and received adjuvant chemotherapy at the Cancer Institute of the State of São Paulo, Brazil. RESULTS: Before adjuvant chemotherapy, 67.8% of patients were classified as overweight or obese according to their body mass indices. Around 66.3% (95% CI 59.7-73.0) of the patients exhibited an increase in the body mass index after adjuvant chemotherapy. The average age of all patients was 56.3±11.3 years. Participants whose body mass index increased were younger than those with no increase (54.7±11.1 versus 59.3±11.2 years; p=0.007). Patients were treated with the following adjuvant chemotherapy regimens: doxorubicin, cyclophosphamide, and paclitaxel (AC-T, 129 patients, 65.8%); 5-fluoracil, doxorubicin, and cyclophosphamide (36 patients, 18.4%); cyclophosphamide, methotrexate, and 5-fluoracil (16 patients, 8.2%); docetaxel and cyclophosphamide (7 patients, 3.6%); and other regimen (8 patients, 4.1%). The AC-T regimen showed a statistically significant association with increase in the body mass index (p<0.001 by ANOVA). CONCLUSIONS: Most patients with breast cancer showed an increase in the body mass index after adjuvant chemotherapy, especially after the AC-T chemotherapy regimen. ResumoOBJETIVO: Avaliar variações no índice de massa corpórea em pacientes que estão passando por quimioterapia devido ao câncer de mama, e relacionar tais alterações com a idade da paciente e o regime de quimioterapia. MÉTODOS: Estudo de coorte retrospectivo que correlacionou variações no índice de massa corpórea pré-e pós-quimioterapia com a idade da paciente e o regime de quimioterapia. Foram excluídas as pacientes que receberam terapia hormonal prévia, seja como tamoxifeno ou inibidores da aromatase. Os dados de 196 pacientes com estágio I a III de câncer de mama foram selecionados, e elas foram tratadas por cirurgia radical ou conservadora que receberam quimioterapia adjuvante no Instituto do Câncer do Estado de São Paulo, Brasil. RESULTADOS: Antes da quimioterapia adjuvante, 67,8% das pacientes foram classificadas com sobrepeso ou obesas de acordo com seus índices de massa corpórea. Aproximadamente 66,3% (IC95% 59,7-73,0) das pacientes exibiram aumento no índice de massa corpórea após a quimioterapia adjuvante. A média de idade das pacientes foi de 56,3±11,3 anos. Pacientes que apresentaram aumento no índice de massa corpórea eram mais jovens do que aquelas que não apresentaram aumento algum (54,7...

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“…Cardiovascular disease risk was often conceptually defined as incidence of cardiovascular diseases including ischemic heart disease, congestive heart failure, myocardial infarction, coronary artery disease, stroke, angina, atrial fibrillation, paroxysmal tachycardia, nonrheumatic valve disease, cardiomyopathy, aortic aneurysm, and arteriosclerosis. [3][4]8,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] While one study included angina as a cardiovascular disease risk factor, 15 Darby et al indicated that angina would not be included as a risk factor due to difficulty with clinical identification of angina. 19 Other investigators conceptually defined cardiovascular disease risk as the presence of cardiovascular disease risk factors including smoking and having an overweight or obese body mass index.…”

Section: Conceptual Definitionsmentioning

confidence: 99%

“…3,[32][33][34][35][36][37][38][39][40] Four studies used self-reported history of cardiovascular diseases or cardiovascular disease risk factors as an operational definition. 23,28,30,31 Attributes According to Rodgers, attributes provide a "real definition as opposed to a nominal or dictionary definition". 12 Attributes are the features that comprise the concept as opposed to the conceptual definition of the concept.…”

Section: Operational Definitionmentioning

confidence: 99%

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Cardiovascular disease risk among breast cancer survivors: an evolutionary concept analysis

Vo¹,

Nolan²,

Vance³

et al. 2017

NRR

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Background: More than 3.5 million breast cancer survivors are living in the US, and the overall five-year survival rate is approaching 90%. With increased survival and cancer treatment-related cardiotoxicities, there has been a rise in cardiovascular diseases among breast cancer survivors. Yet, cardiovascular disease risk among breast cancer survivors has not been well conceptualized. The purpose of this article was to analyze and define the concept of cardiovascular disease risk among breast cancer survivors. Methods: The databases CINAHL, EMBASE, and PubMed were used to identify articles that explored cardiovascular disease risk among breast cancer survivors. The search yielded 357 articles, which were reviewed for eligibility. Thirty articles were selected based on the inclusion/ exclusion criteria. The concept of cardiovascular disease risk among breast cancer survivors was analyzed using Rodgers' evolutionary concept analysis method. Results: The analysis suggests that cardiovascular disease risk among breast cancer survivors consists of several attributes: cancer treatment (chemotherapy, targeted therapies, radiation therapy, and endocrine therapy), modifiable risk factors (obesity, physical inactivity, poor diet, and smoking), and nonmodifiable risk factors (age, family history, and race). The antecedent identified includes breast cancer diagnosis and the consequence identified includes the development of cardiovascular disease. Conclusion: Findings suggest the need for increased education and understanding of cardiovascular disease risk among health care providers and patients. Survivorship care plans can incorporate cardiovascular disease risk monitoring and screening. Future research is needed to explore interventions and develop stratified screening guidelines for breast cancer survivors.

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Determinants of newly diagnosed comorbidities among breast cancer survivors

Abstract: Reducing overweight and regular sport/cycling activities may help to prevent CVD after breast cancer. Patients should be monitored for risk factors and advised on possible cardiac side effects of AI and trastuzumab.

Cited by 21 publications

References 40 publications

Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients

Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients

Variations in the body mass index in Brazilian women undergoing adjuvant chemotherapy for breast cancer

Cardiovascular disease risk among breast cancer survivors: an evolutionary concept analysis

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