Cardiotoxicity among socioeconomically marginalized breast cancer patients

Abstract

Purpose Evidence of cardiotoxicity risk related to anthracycline or trastuzumab exposure is largely derived from breast cancer cohorts that under-represent socioeconomically marginalized women, who may be at increased risk of cardiotoxicity because of high prevalence of cardiovascular disease risk factors. Therefore, we aimed to estimate cardiotoxicity risk among socioeconomically marginalized breast cancer patients treated with anthracyclines or trastuzumab and describe clinical consequences of cardiotoxicity. Methods We linked electronic health records with institutional registry data from a Comprehensive Community Cancer Program within a safety-net health system. Eligible patients were adult females, diagnosed with first primary invasive breast cancer between 2013 and 2017, and initiated anthracyclines or trastuzumab as part of first-line therapy. We estimated cumulative incidence (risk) of cardiotoxicity with corresponding 95% confidence limits (CL) using the Aalen-Johansen estimator with death as competing risk. Results Our study population comprised 169 women with breast cancer (103 initiated anthracyclines and 66 initiated trastuzumab). Cumulative incidence of cardiotoxicity was 21% (95% CL: 12%, 32%) at one year and 25% (95% CL: 15%, 35%) at three years among women who initiated trastuzumab, whereas cumulative incidence was 3.9% (95% CL: 1.3%, 8.9%) at one year and 5.9% (95% CL: 2.4%, 12%) at three years among women who initiated anthracyclines. More than half of patients with cardiotoxicity experienced interruption of cancer treatment. Conclusion Our findings suggest high risk of cardiotoxicity among socioeconomically marginalized breast cancer patients after initiation of anthracyclines or trastuzumab. Strategies are needed for optimizing cancer treatment effectiveness while minimizing cardiotoxicity in this population.

Hypertension Severity and Declines in Left Ventricular Ejection Fraction Among Women Receiving Adjuvant Chemotherapy for Breast Cancer (WF-97415 UPBEAT)

“…These studies may examine the effect of social variables such as race, ethnicity, and drug use and socioeconomic factors such as social support level, residence, education, employment, and income because they can impact cardiac dysfunction and are often present in those with hypertension. 23,24 In conclusion, in the prospective representative study of women with BC receiving potentially cardiotoxic chemotherapy, those with stage II hypertension experienced greater declines in LVEF 3 months after cancer treatment initiation relative to women with normal BP. This finding occurred after accounting for age, BMI, diabetes, tobacco use, number of antihypertensive medications, and pretreatment LVEF.…”

“…These studies may examine the effect of social variables such as race, ethnicity, and drug use and socioeconomic factors such as social support level, residence, education, employment, and income because they can impact cardiac dysfunction and are often present in those with hypertension. 23,24…”