Long-term risk of cerebrovascular accidents in breast cancer patients

Long-term risk of cerebrovascular accidents in breast cancer patients.  With the release of multiple relevant diagnosis and treatment guidelines, the assessment of cardiovascular damage caused by tumor treatment and the path of diagnosis and treatment have become more and more clear.

• Long-term risk of cerebrovascular accident (CVA) in breast cancer patients
• [PD12-04] Long-term risks of cerebrovascular accidents in patients with breast cancer
• Atul Batra1, Shiying Kong2, Rodrigo Rigo1 and Winson Y Cheung1. 1Tom Baker Cancer Center,Calgary, AB, Canada2University of Calgary, Calgary, AB, Canada

Previous survival studies have focused on treatment-related coronary artery disease (CAD) and congestive heart failure (CHF) risks. Although they share a common pathogenic mechanism with CVA, there are limited data on the latter. This real-world evidence study aims to assess the association between breast cancer treatment and the subsequent development of CVA.
research method

The study analyzed patients who were diagnosed with stage I-III breast cancer in a Canadian province between 2004 and 2017, except for those who had previous cardiovascular diseases (including CAD, CHF, arrhythmia and CVA). Correlate the population-based registry data with the administrative agency data to determine whether a patient develops CVA during follow-up after cancer treatment. Adjuvant treatments are classified as none, one, two, or three according to the number of treatment modalities received (chemotherapy, radiation therapy, and hormone therapy). Multivariate logistic regression analysis was performed to determine the association between the number of adjuvant treatments and CVA.
Research result

A total of 23,259 patients were eligible for analysis. The median age is 58 years (interquartile range 22-101 years), 0.5% for men; 49.6% for stage I, 37.1% for stage II, and 13.4% for stage III; 45.0%, 60.6% and 68.1 respectively % Of patients received chemotherapy, radiotherapy and hormone therapy, 11.0% of patients did not receive any adjuvant therapy, and 28.7%, 35.9% and 24.4% of patients received one, two and three methods of treatment .

During a median follow-up of 5.9 years, 1,586 patients (6.8%) developed CVA. The median time from breast cancer diagnosis to CVA was 3.1 years (interquartile range 2.7-3.5 years). Compared with patients who did not receive any adjuvant therapy, patients who received adjuvant therapy had a higher incidence of CVA, any chemotherapy (8.2% vs 5.1%, P<0.001), any radiotherapy (8.3% vs 5.9%, P <0.001) and any hormone therapy (7.8% vs 6.4%, P<0.001). The incidence of CVA was 4.9 in patients who had not received adjuvant therapy and received one, two and three adjuvant treatments, respectively %, 5.9%, 8.2% and 10.5% (P<0.001).

After adjusting for age, it was found that patients who received two or three treatments were more likely to develop CVA than patients who did not receive adjuvant therapy (OR, 1.20; 95% CI, 1.03-1.41; P=0.020 and OR , 1.46; 95% CI, 1.21-1.75; P <0.001), and the risk of developing CVA was similar to that of patients receiving one way of treatment (OR, 1.00; 95% CI, 0.86-1.17, P=0.974). In the multivariate Cox regression model adjusted for stage and treatment, patients with CVA had an increased risk of death (HR, 1.44; 95% CI, 1.30-1.58; P<0.001).
Analysis conclusion

The risk of CVA in patients after breast cancer resection increases with the use of adjuvant therapy. This proportion is highest among patients receiving a combination of chemotherapy, radiotherapy and hormone therapy. When paying close attention to coronary events and cardiomyopathy, breast cancer survivors may benefit from monitoring of CVA risk factors.

Editor’s comments:

With the issuance of multiple relevant diagnosis and treatment guidelines, the assessment of cardiovascular damage caused by tumor treatment and the path of diagnosis and treatment have become more and more clear, but previous survival studies have mainly focused on treatment-related coronary artery disease (CAD) and congestive heart failure In terms of risk (CHF), although there are a large number of the same or similar risk factors and some common pathophysiological basis for cardiovascular and cerebrovascular diseases, the assessment and intervention of CVA caused by radiotherapy and chemotherapy and targeted therapy have not been systematically carried out. The data for these patients is limited.

This real-world evidence study shows that there is a correlation between breast cancer treatment and the subsequent development of CVA. The risk of CVA in patients after breast cancer resection increases with the use of adjuvant therapy. Therefore, strengthen the assessment of cardiovascular toxicity and CVA risk factors in the diagnosis and treatment of cancer patients, and establish a diagnosis and treatment process to achieve early monitoring, early detection, and early treatment, which may improve the long-term survival rate of cancer patients with chemotherapy and targeted therapy.

(source:internet, reference only)

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