scholarly journals Hypertension and Prohypertensive Antineoplastic Therapies in Cancer Patients

2021 ◽  
Vol 128 (7) ◽  
pp. 1040-1061
Author(s):  
Daan C.H. van Dorst ◽  
Stephen J.H. Dobbin ◽  
Karla B. Neves ◽  
Joerg Herrmann ◽  
Sandra M. Herrmann ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Cancer Patients ◽  
Cardiovascular Health ◽  
Systemic Hypertension ◽  
Cancer Therapies ◽  
Cardiovascular Risks ◽  
Increased Risk ◽  
Wide Range ◽  
After Cancer ◽  
Preclinical And Clinical Studies

The development of a wide range of novel antineoplastic therapies has improved the prognosis for patients with a wide range of malignancies, which has increased the number of cancer survivors substantially. Despite the oncological benefit, cancer survivors are exposed to short- and long-term adverse cardiovascular toxicities associated with anticancer therapies. Systemic hypertension, the most common comorbidity among cancer patients, is a major contributor to the increased risk for developing these adverse cardiovascular events. Cancer and hypertension have common risk factors, have overlapping pathophysiological mechanisms and hypertension may also be a risk factor for some tumor types. Many cancer therapies have prohypertensive effects. Although some of the mechanisms by which these antineoplastic agents lead to hypertension have been characterized, further preclinical and clinical studies are required to investigate the exact pathophysiology and the optimal management of hypertension associated with anticancer therapy. In this way, monitoring and management of hypertension before, during, and after cancer treatment can be improved to minimize cardiovascular risks. This is vital to optimize cardiovascular health in patients with cancer and survivors, and to ensure that advances in terms of cancer survivorship do not come at the expense of increased cardiovascular toxicities.

scholarly journals 1465Adverse cardiovascular events after cancer in Queensland, Australia

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Abbey Diaz ◽  
Joan Cunningham ◽  
Daniel Lindsay ◽  
Emily Callander ◽  
Aaron Sverdlov ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Cancer Patients ◽  
Clinical Information ◽  
Cancer Type ◽  
Cancer Therapies ◽  
Optimal Care ◽  
Increased Risk ◽  
Cv Disease ◽  
After Cancer

Abstract Background Cancer survivors are at increased risk of cardiovascular (CV) disease, partially due to cardiotoxic anti-cancer therapies and elevated CV risk factor exposure. We describe the prevalence of adverse CV events in Queensland cancer survivors. Methods The Queensland Cancer Registry (QCR) identified all Queensland residents diagnosed with cancer, July 2012-June 2015. Individuals were included at their first tumour and excluded if diagnosis basis was unknown/post-mortem. The QCR, containing demographic and clinical information, was linked to Queensland Hospital Admitted Patient Data Collection records to evaluate pre-cancer CV comorbidity and post-cancer adverse CV events. All individuals had three years follow-up time. Results 79,377 people with cancer were included. Median diagnosis age was 67 years (IQR 56-76), 44.6% were women, 5.3% had CV comorbidity and the most common cancers were prostate (19.8%), breast (17.3%), and colorectal (15.2%). 10.7% of people had an adverse CV event during follow-up; median time to first event was 362 days (IQR 124-706). Adverse CV events were most common in those aged >35 years vs ≤ 35 (11.0% vs 2%), men vs women (12.3% vs 8.7%), those with vs without CV comorbidity (29.7% vs 9.6%), and in bladder (14.7%), lung (13.1%), or colorectal (12.4%) cancer patients. Conclusions One in ten Queensland cancer patients are hospitalised for adverse CV events in the first three years after cancer diagnosis, associated with CV comorbidity, older age, male sex, and cancer type. Key messages There is urgent need for strategies to identify and deliver optimal care to cancer patients at high CV risk.

scholarly journals Psychosocial status of Hungarian cancer patients. A descriptive study

2014 ◽  
Vol 155 (26) ◽  
pp. 1024-1032
Author(s):  
Magda Rohánszky ◽  
Rózsa Katonai ◽  
Barna Konkolÿ Thege
Keyword(s):  
Cancer Patients ◽  
Social Life ◽  
Normal Population ◽  
Group Method ◽  
Psychosocial Status ◽  
Wide Range ◽  
Psychosocial Difficulties ◽  
Cancer Types ◽  
Population Standards ◽  
After Cancer

Introduction: Psychosocial status of cancer patients is still understudied in Hungary. Aim: The aim of the authors was to obtain current information on the mental and social status of this patient group. Method: Altogether, 1070 cancer patients with a wide range of cancer types were included in the study (30.0% male; age: 55.9±11.0 years). Results: A large part of the patients had serious financial difficulties and 41.3% of them were struggling with at least one more comorbid chronic disease. Further, 52.2% of the patients reported at least moderate anxiety or depression, while the occurrence of suicidal thoughts was almost three times higher among them than in the Hungarian normal population (13.0% vs. 4.6%). Level of perceived social support was also lower than the population standards and 61.6% of the patients reported willingness to benefit from professional psychological support. Quality of social life of the patients deteriorated with time after cancer diagnosis. A positive phenomenon, however, was that the primary coping style reported was active problem solving. Conclusions: The authors conclude that it is necessary to screen cancer patients for psychosocial difficulties and to establish conditions for their adequate mental and social care in Hungary. Orv. Hetil., 2014, 155(26), 1024–1032.

Molecular mechanisms for vascular complications of targeted cancer therapies

2016 ◽  
Vol 130 (20) ◽  
pp. 1763-1779 ◽  
Author(s):  
Srila Gopal ◽  
Kenneth B. Miller ◽  
Iris Z. Jaffe
Keyword(s):  
Cancer Patients ◽  
Molecular Mechanisms ◽  
Cell Function ◽  
Vascular Complications ◽  
Vascular Complication ◽  
Cancer Therapies ◽  
Vegf Inhibitors ◽  
Increased Risk ◽  
Anti Cancer ◽  
Targeted Cancer Therapies

Molecularly targeted anti-cancer therapies have revolutionized cancer treatment by improving both quality of life and survival in cancer patients. However, many of these drugs are associated with cardiovascular toxicities that are sometimes dose-limiting. Moreover, the long-term cardiovascular consequences of these drugs, some of which are used chronically, are not yet known. Although the scope and mechanisms of the cardiac toxicities are better defined, the mechanisms for vascular toxicities are only beginning to be elucidated. This review summarizes what is known about the vascular adverse events associated with three classes of novel anti-cancer therapies: vascular endothelial growth factor (VEGF) inhibitors, breakpoint cluster-Abelson (BCR-ABL) kinase inhibitors used to treat chronic myelogenous leukaemia (CML) and immunomodulatory agents (IMiDs) used in myeloma therapeutics. Three of the best described vascular toxicities are reviewed including hypertension, increased risk of acute cardiovascular ischaemic events and arteriovenous thrombosis. The available data regarding the mechanism by which each therapy causes vascular complication are summarized. When data are limited, potential mechanisms are inferred from the known effects of inhibiting each target on vascular cell function and disease. Enhanced understanding of the molecular mechanisms of vascular side effects of targeted cancer therapy is necessary to effectively manage cancer patients and to design safer targeted cancer therapies for the future.

Impact of precancer multimorbidity clusters on survival and functional outcomes after cancer in older patients.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 291-291 ◽  
Author(s):  
Kelly Kenzik ◽  
Joshua Richman ◽  
Erin E. Kent ◽  
Maria Pisu ◽  
Smita Bhatia
Keyword(s):  
Cancer Patients ◽  
Survey Data ◽  
Cancer Diagnosis ◽  
Functional Impairment ◽  
Regression Models ◽  
Poverty Level ◽  
Risk Of Death ◽  
Increased Risk ◽  
After Cancer ◽  
The Impact

291 Background: While multimorbidity clustering is a significant problem in older adults, the impact of clusters present prior to cancer on post-diagnosis survival and function is unknown. We used SEER-Medicare Health Outcomes Survey data for 4583 cancer patients to address this research gap. Methods: Patients with prostate (1741), breast (BC: 1345), colorectal (CRC: 904) and lung (593) cancer with pre- and post-diagnosis survey data were included. Surveys assessed comorbidity and activities of daily living (ADLs). Previously defined multimorbidity clusters were cardiovascular disease (CVD), skeletal, metabolic, pulmonary + major depressive disorder (MDD), and gastrointestinal (GI) + MDD. Cox regression models estimated hazard ratios (HR) for death after cancer diagnosis. Among those without pre-cancer ADL impairment, modified Poisson regression models estimated relative risk (RR) for developing post-cancer functional impairment (ADL ≤ 4). Models controlled for age, race, education, poverty level, stage, and treatment (radiation, surgery). Results: Median age at cancer diagnosis was 74y (65-103). Post-diagnosis mortality: After 6y median follow-up, mortality was 30%; 5y survival was 74%.Prostate, BC and CRC patients with pre-diagnosis CVD clusters were at increased risk of death compared to those without CVD cluster (HR 1.9, 2.0, 1.7, respectively, p < 0.05). Compared to those without the cluster, prostate and BC patients with metabolic cluster were at increased risk (HR 1.7, 1.9, respectively, p < 0.05) and prostate cancer patients with pulmonary conditions + MDD or GI + MDD (HR 1.9, 2.1, respectively, p < 0.05) were at increased risk. Post-diagnosis functional impairment: Prevalence of moderate functional impairment at a median of 1y after cancer diagnosis was 31%. Prostate, lung, and CRC survivors with GI + MDD had a significant RR of developing impairment (RR 1.8, 1.8, and 1.7, p < 0.001). For BC patients, those with skeletal cluster had a 2.1 RR (p < 0.001). Conclusions: Specific multimorbidity clusters prior to cancer are associated with post-cancer mortality and ADL impairment and identify at-risk groups where interventions can be instituted to decrease morbidity and mortality.

Cardiovascular disease risk in survivors of 20 adult cancers.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11571-11571
Author(s):  
Helen Strongman ◽  
Sarah Gadd ◽  
Anthony Matthews ◽  
Kathryn Mansfield ◽  
Susannah Jane Stanway ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cancer Survivors ◽  
Cox Regression ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cancer Site ◽  
Cvd Risk ◽  
Increased Risk ◽  
Wide Range

11571 Background: There are concerns about long-term cardiovascular disease (CVD) risk in cancer survivors, but few studies have quantified the risks for a wide range of cancers and specific CVD outcomes. Methods: Using UK electronic health records, we identified cohorts of adults alive one year after a cancer diagnosis at 20 different sites. Risks of a range of CVD outcomes were compared to age, sex and general practice matched cancer free controls using Cox regression; crude and adjusted models were compared to investigate the role of shared cancer/CVD risk factors (e.g. smoking and diabetes). Results: 126 120 cancer survivors and 603 144 controls were followed over a median (IQR) 4.6 (2.5-8.1) and 5.6 (3.2-9.2) years. Crude and adjusted hazard ratios (HRs) were similar. In adjusted models, there was strong evidence (p<0.01) of increased risk of CVDs among cancer survivors compared with controls: venous thromboembolism (VTE, 18 cancers), heart failure/cardiomyopathy (7 cancers), arrhythmia (4 cancers), and stroke (3 cancers). In stratified analyses HRs were higher in younger people and continued beyond 5 years post diagnosis. Conclusions: We found increased long term CVD risk among survivors of several cancers compared to the general population, which varied by cancer site and specific CVD outcome.[Table: see text]

Influence of Hypertension and Diabetes on Postoperative Outcomes In Cancer Patients Undergoing Moderate/High Risk Surgical Procedures

2021 ◽  
Author(s):  
Lafayete William Ferreira Ramos ◽  
Beatriz Nery Nascimento ◽  
Gabriel Rossi Silva ◽  
Marcos Vinícius Ferreira Ramos ◽  
Barbara Cristina Ferreira Ramos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Cancer Patients ◽  
Multiple Logistic Regression Analysis ◽  
Diabetic Group ◽  
Postoperative Outcomes ◽  
Morbidity And Mortality ◽  
Systemic Hypertension ◽  
Surgical Time ◽  
Increased Risk

Abstract Background: Systemic hypertension (HTN) and diabetes mellitus (DM) are believed to be risk factors for adverse postoperative outcomes in patients undergoing surgical interventions, but evidence is lacking. This retrospective study evaluated the effects of HTN and DM, alone or in combination, on postoperative outcomes of elective noncardiac surgery in cancer patients. Methods: Patients (n = 844) with malignancies, who underwent elective surgery at a tertiary hospital, were categorised into healthy (group A, n = 339), hypertensive (group B, n = 357), diabetic (group C, n = 21), and hypertensive and diabetic (group D, n = 127) groups. Preoperatively, all patients had systolic blood pressure ≤ 160 mmHg and plasma glucose level ≤ 140 mg/dl. Postoperative in-hospital morbidity and mortality were compared among groups. Results: Postoperative complications occurred in 22 (6.5%), 21 (5.9%), 2 (9.5%), and 11 (8.7%) patients in groups A, B, C, and D, respectively (p = 0.712). HTN (p = 0.538), DM (p = 0.990), and HTN+DM (p = 0.135) did not impact the occurrence of adverse events. Patients with higher surgical risk (ASA III or IV) and those with longer surgical time had higher morbidity and mortality (p = 0.001, p < 0.001, respectively). In multiple logistic regression analysis, ASA status and surgical time were independent risk factors for postoperative complications (both p < 0.001). Conclusion: Cancer patients with preoperative comorbidities, such as HTN and DM, alone or in combination, regardless of other characteristics, do not have an increased risk of adverse postoperative outcomes.Trial registration: Retrospectively registered.

scholarly journals Risks of trastuzumab-related cardiotoxicity in breast cancer patients in Taiwan

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
W T C Chang ◽  
P W C Chen ◽  
H W L Lin ◽  
H S L Lin ◽  
Y H L Li
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Medical Center ◽  
Hazard Ratio ◽  
University Hospital ◽  
Cerebrovascular Event ◽  
Research Database ◽  
Breast Cancer Patients ◽  
Cardiovascular Risks ◽  
Increased Risk

Abstract Aims Despite being an essential therapy for breast cancer, trastuzumab has potential risks of cardiotoxicity. The incidence of trastuzumab-related major adverse cardiac and cerebrovascular event (MACCE) and its predictors remain unknown in Taiwan. Methods and results Through a three-hospital retrospective cohort study, we analyzed the incidence of MACCE in 386 breast cancer patients exposure to trastuzumab from 2010 to 2018. To further reconfirm our findings, in a nationwide study using the Taiwanese National Health Insurance Research Database and National Cancer Registry, we identified 13502 women diagnosed with breast cancer who received chemotherapy from 2010 to 2015 and found 6751 women who received initial treatment with trastuzumab. After 1:1 propensity score matching with trastuzumab nonusers, the incidence of MACCE was measured with a median follow-up of 36 months. In the hospital-based study, among 386 patients receiving trastuzumab, the 5-year incidences of MACCE and heart failure (HF) were 5.4% and 2.8%, respectively. In the national cohort, the crude incidences of MACCEs and HF were 4.67% and 3.21%, respectively. After adjustment for age and comorbidities, the hazard ratio of MACCE was 1.485 (95% CI 1.246–1.769). Notably, among the endpoints, only the hazard ratio of HF was significantly higher in patients receiving trastuzumab than in nonusers. In the subgroup analysis, except for patients also using taxanes, those receiving trastuzumab had a higher risk of MACCE than nonusers. Conclusions From clinical observations in a nationwide cohort, we found an increased risk of MACCE, especially HF, in patients receiving trastuzumab. Given that its cardiotoxicity is independent of traditional cardiovascular risks, our findings highlight critical concerns regarding the cardiac safety of trastuzumab use. FUNDunding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): Chi-Mei Medical Center, National Cheng Kung University Hospital

scholarly journals Identification of CHEK2 germline mutations in BRCA1/2 and PALB2 negative breast and ovarian cancer patients

2022 ◽  
Author(s):  
Fuat Aksoy ◽  
Havva Tezcan Unlu ◽  
Gulsah Cecener ◽  
Gamze Guney Eskiler ◽  
Unal Egeli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Cancer Patients ◽  
Early Onset ◽  
Mutational Analysis ◽  
Turkish Population ◽  
Heteroduplex Analysis ◽  
Chek2 Gene ◽  
Increased Risk ◽  
Wide Range

Introduction: The CHEK2 gene is known to be an important signal transducer involved in DNA repair, apoptosis, or cell cycle arrest in response to DNA damage. The mutations in this gene have been associated with a wide range of cancers, both sporadic and hereditary. Germline CHEK2 mutations are linked to an increased risk of breast cancer. Therefore, the aim of this study was to identify the prevalence of CHEK2 variants in BRCA1/2 and PALB2 negative early-onset patients with breast cancer and/or ovarian cancer in a Turkish population for the first time. Methods: The study included 95 patients with BRCA1/2 and PALB2 negative early-onset breast cancer and/or ovarian cancer and also 60 unaffected women. All the intron/exon boundaries and coding exons of CHEK2 were subjected to mutational analysis by heteroduplex analysis and DNA sequencing. Results: A total of 16 CHEK2 variants were found in breast cancer patients within the Turkish population. CHEK2 c.1100delC mutation studied in the CHEK2 gene most frequently was not detected in our study. The prevalence of variants of uncertain significance in CHEK2 was found to be 7.3% (n= 7) in BRCA1/2 and PALB2 mutation negative Turkish patients with early-onset breast and/or ovarian cancer. Discussion/Conclusion: The present study may shed light on alternative variations that could be significant for understanding the prevalence and clinical suitability of the CHEK2 gene.

Prevalence and predictors of peripheral neuropathy after chemotherapy: Outcomes from the Detroit Research on Cancer Survivorship (ROCS) cohort.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12069-12069
Author(s):  
Kalyan Sreeram ◽  
Randell Seaton ◽  
Mandana Kamgar ◽  
Hadeel Assad ◽  
Mark K. Greenwald ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Reference Group ◽  
Comorbid Condition ◽  
Increased Risk ◽  
Study Population ◽  
After Cancer ◽  
First Time

12069 Background: Increased life expectancy for cancer survivors following advances in treatment has led to a greater likelihood of developing long-term complications. Among them is chemotherapy-induced peripheral neuropathy (CIPN), which adversely impacts the functional capacity of survivors. We assessed prevalence and predictors of CIPN in a cohort of African-American (AA) cancer survivors. Methods: The study population included 633 breast, colorectal, prostate and lung cancer survivors who received chemotherapy and participated in the Detroit Research on Cancer Survivorship (ROCS) study. Presence of CIPN was based on self-reported pain, numbness or tingling in the hands or feet, occurring either for the first time or worsening after chemotherapy. If participants reported continued CIPN at the time of survey, their symptoms were reported as persistent. CIPN severity was self-reported as mild, moderate or severe. Logistic regression analysis was used to evaluate socio-demographic and clinical factors (including 12 common comorbid conditions) associated with CIPN prevalence, persistence and severity. Results: Overall, 67% of the cohort reported CIPN at a mean time of 25.3 months (range 2-74 months) after cancer diagnosis, and 51% reported persistent CIPN. The distribution of CIPN severity consisted of 32.2% with mild, 30.8% with moderate, and 36.9% with moderate to severe symptoms. Diagnosis of primary breast (OR 3.99, 95% CI 1.52-10.46) or colorectal cancers (OR 5.24, 95% CI 2.17-12.69) conferred greater CIPN prevalence relative to a diagnosis of prostate cancer. The presence of each additional comorbid condition among those outlined in the survey also conferred a 20% greater prevalence of CIPN (OR 1.2, 95% CI 1.03-1.39). Similar trends were seen among those who reported persistent CIPN. Using age > 65 at diagnosis as the reference group, age < 50 (OR 2.64, 95% CI 1.43-4.88) and age 51-64 (OR 1.96, 95% CI 1.14-3.35) resulted in an increased risk of moderate or severe compared to mild CIPN. Conclusions: In the Detroit ROCS cohort, CIPN was reported in two-thirds of cancer survivors receiving chemotherapy. Out of them, more than one-third reported moderate to severe symptoms, more commonly seen among those age < 65. Consideration of CIPN as a prominent long-term complication of cancer treatment should play a role in treatment decisions and development of new chemotherapy regimens.

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