HF patients more likely to receive cancer diagnosis

Patients with HF are more likely to be diagnosed with cancer than those without HF, and this trend appears to have increased over time, according to new research published in the Journal of the American College of Cardiology.

Future studies are needed to determine the mechanisms behind this increasing association, but the researchers said possible factors may be related to stress from chronic illness, adverse effects from HF treatments, inflammation and increased surveillance of patients being treated for HF.

Regardless, “these findings underscore the importance of cancer surveillance in the management of HF patients,” Veronique L. Roger, MD, MPH, director of the Mayo Clinic Center for the Science of Health Care Delivery, Rochester, Minn., stated in a press release.

The study was performed under the auspices of the Rochester Epidemiology Project in Olmsted County, Minn. The research team compared Olmsted County residents with an incident diagnosis of HF between 1979 and 2002 (n=961, mean age, 75.5 years; 54% women) with county residents who did not have HF during that time (n=961). Each HF case was matched to a control participant of the same sex and similar age. Then each case–control pair in which neither had any history of cancer (n=596) was followed to compare long-term risk for incident cancer.

During an average 8 years of follow-up, 244 new cancer cases were identified. Patients with HF had a 68% higher risk for developing incident cancer (adjusted HR=1.68; 95% CI, 1.13-2.5) compared with controls.

The researchers found no significant difference in risk for cancer by age or sex. However, cancer risk was more pronounced as time progressed during the study period. Patients diagnosed with HF between 1979 and 1990 had a 48% increased risk for cancer vs. those without HF, and that figure increased to 86% for those diagnosed with HF between 1991 and 2002.

The development of cancer after HF was also associated with increased mortality. Fifty-three percent of HF patients were alive after 5 years of cancer vs. 77% of non-HF controls.

During follow-up, the most pronounced differences in cancer diagnosis between the two groups started at 2 years, reached an apex at 4 years and disappeared at 7 years.

“This suggests that an earlier diagnosis of cancer may have occurred in HF patients,” Anita Deswal, MD, MPH, and Sukhdeep S. Basra, MD, MPH, cardiologists at Baylor College of Medicine, wrote in a related editorial. “In addition, because the development of cancer is usually a slow process, it would be unlikely that HF itself would be the causal factor for the relatively early increase of cancer.”

According to Deswal and Basra, the findings on mortality “suggest that the comorbidity of cancer itself may independently contribute to increased mortality in HF patients, and it is possible that adequate surveillance and treatment of cancers in this population of patients may have a beneficial effect on outcomes.” These findings, “although novel, should be interpreted with caution” until future studies can confirm whether the correlation is merely a product of increased surveillance, they wrote.

For more information:

Deswal A. J Am Coll Cardiol. 2013;[published online ahead of print June 25].

Hasin T. J Am CollCardiol. 2013;[published online ahead of print June 25].

Disclosure: The study was funded by the NIH. The researchers, Basra and Deswal report no relevant financial disclosures.