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Cardiac mortality risk elevated in patients diagnosed with cancer at young age
Patients diagnosed with cancer at age 15 to 19 years who survived at least 5 years had a higher risk for cardiac death compared with patients with a later diagnosis and the general population, according to new data.
“Cardiac disease has been found to be the leading cause of treatment-related nonneoplastic death among survivors of childhood cancer, breast cancer and Hodgkin lymphoma,” Mike M. Hawkins, DPhil, professor of epidemiology and director of the Centre for Childhood Cancer Survivor Studies at the University of Birmingham, England, and colleagues wrote. “As yet, the risk of cardiac mortality has not been investigated comprehensively within a large population of [teenage and young adult] cancer survivors.”
Hawkins and colleagues analyzed cancer survivors from England and Wales diagnosed from age 15 to 39 years who survived at least 5 years after diagnosis (n = 200,945). They calculated standardized mortality ratios, absolute excess risks and cumulative risks. Patients were diagnosed between 1971 and 2006 and followed until 2014 (mean follow-up after 5-year survival, 14.3 years).
Age-based risk
The researchers found that 6% of deaths were caused by heart disease. Patients diagnosed with cancer at age 15 to 19 years had a 4.2 times higher risk for cardiac death (95% CI, 3.4-5.2) vs. the general population of similar age. The standardized mortality ratios decreased for the subsequent age groups, with individuals diagnosed at age 35 to 39 years having a 1.2 higher risk for death from heart disease (95% CI, 1.1-1.3; P for trend < .0001).
The pattern was consistent across different types of heart disease, including ischemic heart disease, valvular heart disease and cardiomyopathy, Hawkins and colleagues found.
“It is important for clinicians because it helps them focus the most intensive follow-up care on those more at risk,” Hawkins said in a press release. “It is important for survivors because it empowers them by providing them with their long-term chances of a specific side effect of cancer treatment.”
The study also reported survivors of Hodgkin lymphoma had a higher risk for heart disease death, which was 3.8 times that of the general population. Of those diagnosed at age 15 to 19 years with Hodgkin lymphoma, 6.9% died of heart disease by age 55 years vs. 2% in those diagnosed at age 35 to 39 years. Among survivors of Hodgkin lymphoma older than 60 years, nearly 30% of the excess deaths were caused by heart disease, according to the researchers.
Excess cardiac death
Compared with the general population, survivors of acute myeloid leukemia had 2.7 times as many cardiac deaths, according to the researchers, who also wrote that survivors of genitourinary cancers other than bladder cancer, non-Hodgkin lymphoma, lung cancer, other types of leukemia, central nervous system tumor, cervical cancer and breast cancer had between 1.2 and two times as many cardiac deaths vs. the general population.
“This study demonstrates for the first time that age at cancer diagnosis is important in determining the excess risk of cardiac death among an entire population of survivors of [teenage and young adult] cancer,” researchers wrote. “This age at diagnosis effect was primarily accounted for by survivors of Hodgkin lymphoma and breast cancer, providing useful risk stratification evidence.” – by Cassie Homer
Disclosure: The researchers report no relevant financial disclosures.