Impact of pre-existing cardiovascular disease on treatment patterns and survival outcomes in patients with lung cancer

Abstract

Background Baseline cardiovascular disease (CVD) can impact the patterns of treatment and hence the outcomes of patients with lung cancer. This study aimed to characterize treatment trends and survival outcomes of patients with pre-existing CVD prior to their diagnosis of lung cancer. Methods We conducted a retrospective, population-based cohort study of patients with lung cancer diagnosed from 2004 to 2015 in a large Canadian province. Multivariable logistic regression and Cox regression models were constructed to determine the associations between CVD and treatment patterns, and its impact on overall (OS) and cancer-specific survival (CSS), respectively. A competing risk multistate model was developed to determine the excess mortality risk of patients with pre-existing CVD. Results A total of 20,689 patients with lung cancer were eligible for the current analysis. Men comprised 55%, and the median age at diagnosis was 70 years. One-third had at least one CVD, with the most common being congestive heart failure in 15% of patients. Pre-existing CVD was associated with a lower likelihood of receiving chemotherapy (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.48–0.58; P < .0001), radiotherapy (OR, 0.76; 95% CI, 0.7–0.82; P < .0001), and surgery (OR, 0.56; 95% CI, 0.44–0.7; P < .0001). Adjusting for measured confounders, the presence of pre-existing CVD predicted for inferior OS (hazard ratio [HR], 1.1; 95% CI, 1.1–1.2; P < .0001) and CSS (HR, 1.1; 95% CI, 1.1–1.1; P < .0001). However, in the competing risk multistate model that adjusted for baseline characteristics, prior CVD was associated with increased risk of non-cancer related death (HR, 1.48; 95% CI, 1.33–1.64; P < 0.0001) but not cancer related death (HR, 0.98; 95% CI, 0.94–1.03; P = 0.460). Conclusions Patients with lung cancer and pre-existing CVD are less likely to receive any modality of cancer treatment and are at a higher risk of non-cancer related deaths. As effective therapies such as immuno-oncology drugs are introduced, early cardio-oncology consultation may optimize management of lung cancer.

Non-cancer Causes of Death Following Initial Synchronous Bone Metastasis in Cancer Patients

“…Our results postulated the upper hand of cardiovascular and cerebrovascular diseases as a non-cancer-related cause of death in patients with BM, which was consistent with previous studies. Batra et al concluded that patients with lung cancer and pre-existing cardiovascular disease had a higher risk of dying from non-cancer causes than cancer causes ( 18 ). Compared to the general population, the SMR of fatal heart disease in cancer patients was up to 2.24 (95% CI : 2.23–2.25) ( 19 ).…”

Are cardiovascular comorbidities always associated with a worse prognosis in patients with lung cancer?

“…The hypothesis that the effect of chronic cardiac comorbidities on mortality is dominant in early stages of lung cancer seems most plausible. Data on 95 167 NSCLC patients showed that cardiovascular disease can increase mortality when the cancer stage is in the range I-III B, while it is not important for survival in stage IV (10). Worse prognosis was associated with concomitant heart failure, myocardial infarction, and arrhythmias diagnosed during follow-up, although the risk still varied depending on the stage of the disease and the treatment method.…”

“…Retrospective cohort studies have shown that cancer-related mortality rates for biologically aggressive malignancies exceed those for comorbidities (8,9). Batra et al showed that patients with lung cancer and CV diseases were less likely to receive oncological treatment, whether chemotherapy, targeted therapy or radiotherapy (10). It has also been shown that prior CV disease increases the risk of cancer-unrelated death (HR = 1.48; p < 0.0001) and does not contribute to cancer-related mortality.…”

“…The prevalence in lung cancer patients seems to be higher because ranges from 10.3% (10) to 33.7% (47), depending on the source. Every third patient (33%) from those with cardiovascular disease had previous myocardial infarction (10).…”

Cancer treatment-related cardiac dysfunction in breast cancer survivors: A retrospective descriptive study using electronic health records from a Korean tertiary hospital

“…However, concerns regarding treatment-related cardiotoxicity may serve as obstacles to receiving proper cancer treatment. For example, a recent study noted that pre-existing CVDs, which is known to be a risk factor for cardiotoxicity, were related to lower odds of receiving chemotherapy, radiotherapy, and surgery for lung cancer (Batra et al, 2020). This may be because these patients were considered too frail to receive standard treatments or at an intensified risk for cardiotoxicity due to cancer treatments.…”