Published in Journal of the American College of Cardiology (JACC) CardioOncology. Here is a link to the article.
Regenstrief Institute authors: Jiang Bian, PhD
Abstract
Background: Prior research suggests that breast cancer patients with a high burden of frailty may face an increased risk of cardiotoxicity.
Objectives: This study sought to examine the association between frailty and cardiotoxicity rates in female breast cancer patients receiving adjuvant therapy after surgery.
Methods: We analyzed data from the OneFlorida+ clinical research network, focusing on breast cancer patients treated with adjuvant chemotherapy and targeted therapy from 2012 to 2022. Cardiovascular rates during adjuvant treatments were calculated based on pre-existing frailty, measured using the cumulative deficit frailty index (electronic health record frailty index). We employed multivariable Gray’s method to examine the association between frailty with cardiotoxicity.
Results: The final cohort included 2,050 patients (mean age 50.6 years), with 415 (20.2%) experiencing nonfatal adverse cardiovascular events after adjuvant therapy. The incidence of adverse cardiovascular events was 17.8% in robust, 23.2% in prefrail, and 29.4% in frail patients. In multivariable analysis, prefrail (adjusted subdistribution HR [sHR]: 1.35; 95% CI: 1.06-1.71; P = 0.015) and frail (adjusted sHR: 1.70; 95% CI: 1.11-2.61; P = 0.015) patients had a higher likelihood of experiencing adverse cardiovascular events compared with robust patients. Among non-Hispanic White and Black patients, prefrail (adjusted sHR: 1.48; 95% CI: 1.04-2.11; P = 0.031; and adjusted sHR: 1.59; 95% CI: 1.06-2.37; P = 0.024, respectively) and frail (adjusted sHR: 1.96; 95% CI: 1.10-3.50; P = 0.022; and adjusted sHR: 2.13; 95% CI: 1.11-4.10; P = 0.023, respectively) patients were more likely to experience adverse cardiovascular events compared with robust patients. No significant differences were observed in other racial/ethnic groups.
Conclusions: These findings highlight the need for close monitoring of cardiotoxicity in frail breast cancer patients undergoing adjuvant treatments to improve cardiovascular risk management.
Authors
Shuang Yang 1, Xiwei Lou 1, Mustafa M Ahmed 2, Stephen E Kimmel 3, Karen C Daily 4, Thomas J George 4, Carl J Pepine 2, Jiang Bian 5, Dejana Braithwaite 6, Dongyu Zhang 7, Yi Guo 8
Affiliations
1Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA.
2Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA.
3Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA.
4Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA.
5Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA; Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, Florida, USA.
6Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA; Department of Surgery, University of Florida, Gainesville, Florida, USA.
7Janssen Research and Development, LLC, Raritan, New Jersey, USA. Electronic address: dzhan107@its.jnj.com.
8Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA; Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, Florida, USA. Electronic address: yiguo@ufl.edu.
