Heart failure patients more likely to receive cancer diagnosis

Issue: August 25, 2013

Individuals with heart failure are more likely to be diagnosed with cancer than those without heart failure, and the trend appears to have increased over time, according to study results.

Stress from chronic illness, adverse effects from heart failure treatments, inflammation and increased surveillance of patients treated for heart failure all may contribute to the association, researchers wrote.

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

Researchers performed the study under the auspices of the Rochester Epidemiology Project in Olmsted County, Minn.

Veronique L. Roger

The analysis included 961 Olmsted County residents with an incident diagnosis of heart failure between 1979 and 2002 (mean age, 75.5 years; 54% women), as well as 961 county residents who did not have heart failure during that time. The heart failure patients were matched to a control participant of the same sex and similar age.

Researchers identified 596 case-control pairs in which neither person had a history of cancer. Researchers followed those pairs to compare long-term risk for incident cancer.

During an average 8 years of follow-up, researchers identified 244 new cancer cases.

Patients with heart failure had a 68% higher risk for developing incident cancer (adjusted HR=1.68; 95% CI, 1.13-2.5) compared with controls. The most frequent types were cancers of the digestive system, cancers of the male reproductive system, hematologic malignancies, breast cancer and lung cancer.

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 heart failure between 1979 and 1990 had a 48% increased risk for cancer vs. those without heart failure, and that figure increased to 86% for those diagnosed with heart failure between 1991 and 2002.

“These findings illustrate the importance of multi-morbidity among patients living with chronic diseases and support the concept of providing holistic rather than disease-based care,” Roger and colleagues wrote.

The development of cancer after heart failure also was associated with increased mortality. Fifty-three percent of heart failure patients were alive 5 years after cancer diagnosis, compared with 77% of the 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 heart failure 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 heart failure itself would be the causal factor for the relatively early increase of cancer.”

The results “suggest that the comorbidity of cancer itself may independently contribute to increased mortality in heart failure patients, and it is possible that adequate surveillance and treatment of cancers in this population of patients may have a beneficial effect on outcomes,” Deswal and Basra wrote.

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 added.

Heart failure patients more likely to receive cancer diagnosis

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