Correlation of a family history of cancer with risk of relapse and death in pediatric cancer patients

10029 Background: The association between family history of cancer (FHC) and outcome remains uncertain. Relapse and survival of children with FHC has not been well studied. Such information would be valuable for prognosis, refining treatment protocols, and long-term follow-up in pediatric patients with FHC. Methods: An historical cohort study of all pediatric patients diagnosed with cancer at Lucile Packard Children's Hospital at Stanford from 1999 - 2002 was performed (n = 363, mean age: 8.4 yrs [0–28 yrs]). FHC among 1st, 2nd and 3rd degree relatives was obtained from the first 10 consecutive encounters in the electronic medical record. Relapse, secondary malignancy, and survival data were also acquired. The relative risks for these endpoints were calculated between patients with FHC among 1st and/or 2nd degree relatives and those with negative FHC. Patients without documented FHC were excluded (n = 100). Results: 108 (41%) newly diagnosed pediatric patients had reported FHC (1st Degree: n = 14 [5%], 2nd Degree: n = 58 [22%], 3rd Degree: n = 36 [14%]). Patients with reported FHC among 1st and/or 2nd degree relatives were at increased relative risk [RR] for relapse (1.96, 95% confidence interval [CI] 1.27–3.02) compared to patients with negative FHC (n = 191). In particular, patients with Hodgkin Disease (HD) and FHC (n = 12) were more likely to relapse (RR 1.79, 95% CI 1.19–2.72) and at increased risk of death (RR 1.72, 95% CI 1.18–2.53), compared to HD with negative FHC (n = 8). Similarly, patients diagnosed with ALL and FHC (n = 22) had increased risk of death (RR 2.25, 95% CI 1.06–4.8) compared to ALL patients with negative FHC (n = 56). For patients diagnosed with any pediatric cancer and positive FHC in 1st degree relative, RR of death was significantly elevated (3.74, 95% CI 1.20–11.70). Conclusions: Pediatric cancer patients with positive FHC among 1st and/or 2nd degree relatives appear to have higher relative risk of relapse compared to those with negative FHC. Additionally, an increased risk of death was associated with HD and ALL patients with positive FHC. Patients with 1st degree relative with malignancy had an increased risk for death compared to those without cancer among 1st degree relatives. These findings may reflect underlying genetic predispositions in children which contribute to outcome. No significant financial relationships to disclose.

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Family history of cardiovascular disease and cardiovascular comorbidities risk in a pediatric cancer population.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.10518 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 10518-10518

Author(s):

Thomas Patrick Curtin ◽

Wendy Kohlmann ◽

Luke Devon Maese ◽

Zhe Yu ◽

Karen Curtin ◽

...

Keyword(s):

Cardiovascular Disease ◽

Family History ◽

Cancer Patients ◽

Pediatric Cancer ◽

Pediatric Patients ◽

Cvd Risk ◽

First Degree Relatives ◽

Pediatric Cancers ◽

Pediatric Cancer Patients ◽

History Of

10518 Background: Survival rates for childhood cancer patients have improved dramatically, but the growing survivor population suffers from increased treatment-related toxicity including high risk for cardiovascular disease (CVD). While the link between chemotherapy and radiation to cardiotoxicity is well established, few studies seek to determine if an underlying familial risk for cardiovascular disease contributes or predicts this risk. The Utah Population Database (UPDB) is a genealogical resource linked to statewide cancer diagnoses and electronic medical data in which family history is objectively determined. Methods: We calculated the risk of subsequent CVD (ICD-9 401-449) in relatives of 5602 pediatric cancer patients diagnosed at ages 0-19 in Utah from 1966-2013 with no congenital CVD-related anomalies (ICD-9 745-747, 758-759). We identified 964 patients with subsequent CVD diagnoses. Cox models provided recurrence-risk estimates in first-degree relatives of patients compared to relatives of 5:1 matched controls. Results: Pediatric cancer patients were at 5-fold risk of CVD compared to controls ( P< 10-15). In pediatric patients with subsequent CVD, first-degree relatives were at 30% increased CVD risk compared to relatives of cancer-free controls (HR = 1.31, 95%CI 1.16-1.47; P< 10-5). In pediatric patients without CVD, only parents exhibited slight CVD risk (HR = 1.08, 95%CI 1.03-1.14; P= 0.002). In 685,000 individuals with a non-congenital CVD history, pediatric cancers among their first-degree relatives were associated with a similar increased risk of subsequent CVD, compared to pediatric cancers among relatives of controls with no CVD events (HR = 1.39, 95%CI 1.18-1.64, P< 10-4). Conclusions: The UPDB is powerful for investigating comorbidities in cancer patients and their families without recall bias from self-reported family medical history. A family history of CVD may increase risk of CVD-related comorbidities among pediatric cancer patients by 30-40% beyond that observed in patients without a CVD family history. This finding suggests that in addition to a cancer family history, a CVD-related family history should be assessed in children diagnosed with cancer.

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Clinical characteristics, outcomes, and risk factors for mortality in hospitalized patients with COVID-19 and cancer history: a propensity score-matched study

Infectious Agents and Cancer ◽

10.1186/s13027-020-00339-y ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Majid Sorouri ◽

Amir Kasaeian ◽

Helia Mojtabavi ◽

Amir Reza Radmard ◽

Shadi Kolahdoozan ◽

...

Keyword(s):

Mortality Rate ◽

Solid Tumors ◽

Survival Prediction ◽

Female Ratio ◽

Presenting Symptoms ◽

Risk Of Death ◽

Cancer Group ◽

Increased Risk ◽

History Of ◽

History Of Cancer

Abstract Background COVID-19 has caused great concern for patients with underlying medical conditions. We aimed to determine the prognosis of patients with current or previous cancer with either a PCR-confirmed COVID-19 infection or a probable diagnosis according to chest CT scan. Methods We conducted a case control study in a referral hospital on confirmed COVID-19 adult patients with and without a history of cancer from February25th to April21st, 2020. Patients were matched according to age, gender, and underlying diseases including ischemic heart disease (IHD), diabetes mellitus (DM), and hypertension (HTN). Demographic features, clinical data, comorbidities, symptoms, vital signs, laboratory findings, and chest computed tomography (CT) images have been extracted from patients’ medical records. Multivariable logistic regression was used to estimate odd ratios and 95% confidence intervals of each factor of interest with outcomes. Results Fifty-three confirmed COVID-19 patients with history of cancer were recruited and compared with 106 non-cancerous COVID-19 patients as controls. Male to female ratio was 1.33 and 45% were older than 65. Dyspnea and fever were the most common presenting symptoms in our population with 57.86 and 52.83% respectively. Moreover, dyspnea was significantly associated with an increased rate of mortality in the cancer subgroup (p = 0.013). Twenty-six patients (49%) survived among the cancer group while 89 patients (84%) survived in control (p = 0.000). in cancer group, patients with hematologic cancer had 63% mortality while patients with solid tumors had 37%. multivariate analysis model for survival prediction showed that history of cancer, impaired consciousness level, tachypnea, tachycardia, leukocytosis and thrombocytopenia were associated with an increased risk of death. Conclusion In our study, cancer increased the mortality rate and hospital stay of COVID-19 patients and this effect remains significant after adjustment of confounders. Compared to solid tumors, hematologic malignancies have been associated with worse consequences and higher mortality rate. Clinical and para-clinical indicators were not appropriate to predict death in these patients.

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Outcomes of the 2019 novel coronavirus in patients with or without a history of cancer: a multi-centre North London experience

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835920956803 ◽

2020 ◽

Vol 12 ◽

pp. 175883592095680 ◽

Cited By ~ 2

Author(s):

Nalinie Joharatnam-Hogan ◽

Daniel Hochhauser ◽

Kai-Keen Shiu ◽

Hannah Rush ◽

Valerie Crolley ◽

...

Keyword(s):

Cancer Patients ◽

Composite Endpoint ◽

Time Interval ◽

Patients With Cancer ◽

Risk Of Death ◽

Increased Risk ◽

History Of ◽

Novel Coronavirus ◽

History Of Cancer ◽

North London

Background: This study aims to compare the outcomes of COVID-19-positive disease in patients with a history of cancer to those without. Methods: We retrospectively collected clinical data and outcomes of COVID-19 positive cancer patients treated consecutively in five North London hospitals (cohort A). Outcomes recorded included time interval between most recent anti-cancer treatment and admission, severe outcome [a composite endpoint of intensive care unit (ITU) admission, ventilation and/or death] and mortality. Outcomes were compared with consecutively admitted COVID-19 positive patients, without a history of cancer (cohort B), treated at the primary centre during the same time period (1 March–30 April 2020). Patients were matched for age, gender and comorbidity. Results: The median age in both cohorts was 74 years, with 67% male, and comprised of 30 patients with cancer, and 90 without (1:3 ratio). For cohort B, 579 patients without a history of cancer and consecutively admitted were screened from the primary London hospital, 105 were COVID-19 positive and 90 were matched and included. Excluding cancer, both cohorts had a median of two comorbidities. The odds ratio (OR) for mortality, comparing patients with cancer to those without, was 1.05 [95% confidence interval (CI) 0.4–2.5], and severe outcome (OR 0.89, 95% CI 0.4–2.0) suggesting no increased risk of death or a severe outcome in patients with cancer. Cancer patients who received systemic treatment within 28 days had an OR for mortality of 4.05 (95% CI 0.68–23.95), p = 0.12. On presentation anaemia, hypokalaemia, hypoalbuminaemia and hypoproteinaemia were identified predominantly in cohort A. Median duration of admission was 8 days for cancer patients and 7 days for non-cancer. Conclusion: A diagnosis of cancer does not appear to increase the risk of death or a severe outcome in COVID-19 patients with cancer compared with those without cancer. If a second spike of virus strikes, rational decision making is required to ensure optimal cancer care.

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Family History of Cancer and Tobacco Exposure in Index Cases of Pancreatic Ductal Adenocarcinoma

Journal of Oncology ◽

10.1155/2011/215985 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

R. Lochan ◽

A. K. Daly ◽

H. L. Reeves ◽

R. M. Charnley

Keyword(s):

Pancreatic Cancer ◽

Family History ◽

Pancreatic Adenocarcinoma ◽

Ductal Adenocarcinoma ◽

Tobacco Exposure ◽

Degree Relative ◽

Family History Questionnaire ◽

Increased Risk ◽

History Of ◽

History Of Cancer

Aim. To examine interaction between history of cancer in first-degree relatives and tobacco smoking in index patients of pancreatic adenocarcinoma.Methods. We carried out a case-control involving 113 patients with pancreatic adenocarcinoma and 110 controls over a 12-month period at the Freeman Hospital, Newcastle upon Tyne, UK. They were all administered a detailed tobacco exposure questionnaire and a family history questionnaire. We calculated cumulative tobacco exposure and risk for pancreas cancer.Results. Both smokers (OR 3.01 (95% CI: 1.73 to 5.24)) and those with a family history of malignancy (OR 1.98 (95% CI: 1.15–3.38)) were more likely to develop pancreatic cancer. Having more than one first-degree relative with cancer did not significantly further increase the risk of pancreatic cancer. Amongst pancreatic cancer cases, cumulative tobacco exposure was significantly decreased () in the group of smokers (current and ex-smokers) who had a family history of malignancy [mean (SD): 30.00 (24.77) pack-years versus 44.69 (28.47) pack-years with no such history].Conclusions. Individuals with a family history of malignancy are at an increased risk of pancreatic cancer. Furthermore, individuals with a family history of malignancy and who smoke appear to require a lesser degree of tobacco exposure for the development of pancreatic cancer.

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Clinical characteristics, outcomes, and risk factors for mortality in hospitalized patients with COVID-19 and cancer history: a propensity score-matched study

10.21203/rs.3.rs-98559/v1 ◽

2020 ◽

Author(s):

Majid Sorouri ◽

Amir Kasaeian ◽

Helia Mojtabavi ◽

Amir Reza Radmard ◽

Shadi Kolahdoozan ◽

...

Keyword(s):

Solid Tumors ◽

Hematologic Malignancies ◽

Cancer History ◽

Clinical Indicators ◽

Female Ratio ◽

Risk Of Death ◽

Hematologic Cancer ◽

Increased Risk ◽

History Of ◽

History Of Cancer

Abstract Background: COVID-19 has caused great concern for patients with underlying medical conditions. We aimed to determine the prognosis of patients with current or previous cancer with either a PCR-confirmed COVID-19 infection or a probable diagnosis according to chest CT scan.Methods: We conducted a case control study in a referral hospital on confirmed COVID-19 adult patients with and without a history of cancer from February25th to April21st, 2020. Patients were matched according to age, gender, and underlying diseases. Demographic features, clinical and Para clinical data have been extracted from medical records. Multivariable logistic regression was used to estimate odd ratios and 95% confidence intervals of each factor of interest with outcomes. Results: Fifty-three confirmed COVID-19 patients with history of cancer were recruited and compared with 106 non-cancerous COVID-19 patients. Male to female ratio was 1.33 and 45% were older than 65. Dyspnea was significantly associated with an increased rate of mortality in the cancer subgroup (p=0.013). Twenty-six patients (49%) survived among the cancer group while 89 patients (84%) survived in control (p=0.000). Patients with hematologic cancer had 63% mortality while those with solid tumors had 37%. Multivariate analysis showed that cancer, impaired consciousness, tachypnea, tachycardia, leukocytosis and thrombocytopenia were associated with an increased risk of death.Conclusion: Cancer increased mortality rate and hospital stay of COVID-19 patients and remained significant after adjustment of confounders. Compared to solid tumors, hematologic malignancies have been associated with worse consequences and higher mortality. Clinical and Para clinical indicators were not appropriate to predict death.

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Family History of Cancer and Risk of Lymphoma: Influence of IL8RB, GGH IVS7 and IL10 Polymorphisms.

Blood ◽

10.1182/blood.v112.11.1777.1777 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1777-1777

Author(s):

Eva Domingo-Domènech ◽

Yolanda Benavente ◽

Carlos Montalbán ◽

Ramon Bosch ◽

Josep Gumà ◽

...

Keyword(s):

Family History ◽

Variant Allele ◽

Degree Relative ◽

Family History Of Cancer ◽

Increased Risk ◽

Inheritance Model ◽

History Of ◽

Additive Inheritance ◽

History Of Cancer

Abstract Background and aims: Family history of cancer in lymphoma patients has largely been described. On the other hand, genetic susceptibility associated to lymphoma risk is being investigated at the present time. However, single nucleotide polymorphisms (SNPs) associated to the entity among those reporting family history of cancer have yet not been identified. In a previous study of our group, we identified that the probability of having a first-degree relative with cancer was significantly higher among the patients with lymphoid neoplasm than among the control subjects (43% vs 35%, p<0.05). When analysing by lymphoma subtypes, B-cell lymphoma, chronic lymphocytic leukaemia (CLL) and multiple myeloma (MM) patients were significantly more likely to report a first-degree relative with any cancer, with a risk increase ranging from 1.4 up to 2.1 among CLL patients. Thus, a 2-to 4-fold increased risk of lymphoma has been identified in patients with a family history of hematologic disease or lymphoma in first-degree relatives, with CLL, MM and Hodgkin’s lymphoma (HL) being the three entities more consistently reported. The purpose of this study was to evaluate the role of genetic variants of several polymorphisms in the risk of developing a lymphoid neoplasm among subjects with family history of cancer in the case-control study Epilymph. Material and methods: Newly diagnosed cases of lymphoma were recruited between 1998–2002 in 4 Spanish centers. Controls were hospitalized patients matched to the cases by age, gender and study center. Personal interviews were conducted in order to collect data on demographics, environmental exposure, medical and family history, including cancer. The site of cancer, age at diagnosis, and status of any affected relatives with cancer were requested. In this analysis, we only included those subjects who reported a family history of cancer. 72 SNPs in 47 genes were included in the analysis. DNA of 503 cases and 569 controls were genotyped using the TaqmanTM platform. Odds Ratios (OR) and 95% confidence intervals (CI) for the association of the variants with the risk of lymphoma were calculated using unconditional logistic regression analysis, under the log additive inheritance model. Results: Family history of cancer was reported by 421 subjects (196 controls and 225 cases, p-value=0.001). Among those, 41 had an hematological origin. The two SNP genotyped in IL8RB gene were associated to an increase in risk of lymphoma for every extra variant allele (IL8RB +1235C>T OR=1.68, 95%CI=1.25–2.27 and IL8RB -1010A>G OR=1.59, 95%CI=1.17–2.17). The OR associated to an additional variant allele of Ggh IVS7-3001 polymorphism was 1.82 (95%CI=1.06–3.14). IL-1082 A>G was observed to decrease the risk of lymphoma (OR=0.72, 95%CI=0.54–0.96).Restricting the analysis to those with a familial cancer of hematological origin under a log-additive inheritance model, a statistical increase in the risk was found for every extra variant allele MTHFR +429A>C in the genotype (OR=21.52, 95%CI=2.42–191.08), whereas presenting at least one variant allele of IL10 -1082 A>G decreased the risk of lymphoma (OR=0.05, 95%CI=0.01–0.38). In order to evaluate the association between SNPs and lymphoma subtypes in subjects with family history of cancer, we explored the relation between all statistically significant SNPs reported above and non-Hodgkin lymphomas (NHL), Chronic lymphocytic leukemia (CLL), multiple myeloma (MM), and Hodgkin lymphoma (HL). We observe that the association of SNPs and all lymphoma is similar after stratifying by subtypes, although these results are based on few subjects. Interestingly, those SNPs related to low risk of lymphoma, were observed to have the lowest risk among HL cases (IL10 -1082 A>G OR=0.28, 95%CI=0.09– 0.82), whereas HL and MM seems to be at higher risk for those SNPs related to increased risk of lymphoma (IL8RB+1235 OR=2.29, 95%CI=1.29–4.05 and IL8RB-1010 OR=2.45, 95%CI=1.33–4.51 for MM and Ggh IVS7-3001 OR=5.47, 95%CI=1.33–22.52 for HL). Conclusions: These results suggest a potential role of IL8RB, GGH IVS7 and IL10 SNPs in the risk of lymphoid neoplasms among subjects with family history of cancer. HL and MM seem to be those entities in which these associations appear to be stronger, although the number of cases included is small.

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Improving the rate of influenza vaccination in pediatric patients with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.49 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 49-49

Author(s):

Jason Lawrence Freedman ◽

Anne F. Reilly ◽

L. Charles Bailey

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Cancer Patients ◽

Pediatric Cancer ◽

Pediatric Patients ◽

Provider Education ◽

Clinical Process ◽

Patients With Cancer ◽

Increased Risk ◽

Pediatric Cancer Patients

49 Background: Pediatric patients with cancer are at increased risk of influenza, with high mortality, morbidity, and delay of cancer therapy. CDC guidelines support yearly vaccination in these patients. In prior years at our center, only 53-56% of pediatric cancer patients received at least one dose of the vaccine. Our objective was to increase the rates of influenza vaccination in pediatric cancer patients through a multi-faceted QI initiative. Methods: Five interventions were instituted concomitantly, in eligible patients (>6 months old, >100 days from BMT if applicable, and within 1 year of chemotherapy) over a 6-month period (9/1/12 to 3/31/13). 1) Family education: provision of influenza/vaccine handouts to families in clinic waiting rooms; 2) Health informatics intervention: via electronic health records, generation of daily lists of patients due for doses with automated email lists to triage and nurses; 3) Clinical process interventions: standardization of triage process to identify patients needing vaccination and provision of colored wristbands to such patients alerting providers to order the vaccine, or document refusals, during the encounter; 4) Inpatient orders: influenza vaccine order built into computerized physician admission order set to trigger vaccination upon discharge; and 5) Provider education: printed materials and tutorials for staff at conferences on proper screening of patients, vaccine ordering/dose, and correct documenting of refusals/contraindications. These processes were iteratively refined over the 6-month timeframe. Results: Influenza immunization rates increased by 20% after the changes were implemented; this was seen across all tumor subgroups. Overall, 74% of patients received at least one dose as compared with 52% in the prior year. 61% of patients were fully immunized (vs. 42% in 2011-12). Immunizations were deferred due to allergy/refusal in 8% of patients (vs. 7% in 2011-12). Consequently, only 18% of eligible patients were unimmunized as compared to 41% in the prior year. Conclusions: Technology, education, and clinical process changes led to a successful increase in influenza vaccination rates. Ongoing efforts will target subgroups with lowest overall rates of immunization.

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Family History of Diabetes Is Associated with Increased Risk of Recurrent DKA in Pediatric Patients in Rhode Island

Diabetes ◽

10.2337/db18-1378-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1378-P

Author(s):

JANAKI D. VAKHARIA ◽

SUNGEETA AGRAWAL ◽

JANINE BACIC ◽

LISA S. TOPOR

Keyword(s):

Family History ◽

Rhode Island ◽

Pediatric Patients ◽

Family History Of Diabetes ◽

Increased Risk ◽

History Of

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Mortality and high risk of major adverse events in patients with COVID-19 and history of cardiovascular disease

Open Heart ◽

10.1136/openhrt-2020-001526 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001526

Author(s):

Elena Tessitore ◽

David Carballo ◽

Antoine Poncet ◽

Nils Perrin ◽

Cedric Follonier ◽

...

Keyword(s):

Hospital Mortality ◽

Male Gender ◽

Hospital Death ◽

Chronic Obstructive ◽

University Hospitals ◽

Adverse Cardiovascular Event ◽

Risk Of Death ◽

Hospitalised Patients ◽

Increased Risk ◽

History Of

ObjectiveHistory of cardiovascular diseases (CVDs) may influence the prognosis of patients hospitalised for COVID-19. We investigated whether patients with previous CVD have increased risk of death and major adverse cardiovascular event (MACE) when hospitalised for COVID-19.MethodsWe included 839 patients with COVID-19 hospitalised at the University Hospitals of Geneva. Demographic characteristics, medical history, laboratory values, ECG at admission and medications at admission were collected based on electronic medical records. The primary outcome was a composite of in-hospital mortality or MACE.ResultsMedian age was 67 years, 453 (54%) were males and 277 (33%) had history of CVD. In total, 152 (18%) died and 687 (82%) were discharged, including 72 (9%) who survived a MACE. Patients with previous CVD were more at risk of composite outcomes 141/277 (51%) compared with those without CVD 83/562 (15%) (OR=6.0 (95% CI 4.3 to 8.4), p<0.001). Multivariate analyses showed that history of CVD remained an independent risk factor of in-hospital death or MACE (OR=2.4; (95% CI 1.6 to 3.5)), as did age (OR for a 10-year increase=2.2 (95% CI 1.9 to 2.6)), male gender (OR=1.6 (95% CI 1.1 to 2.3)), chronic obstructive pulmonary disease (OR=2.1 (95% CI 1.0 to 4.2)) and lung infiltration associated with COVID-19 at CT scan (OR=1.9 (95% CI 1.2 to 3.0)). History of CVD (OR=2.9 (95% CI 1.7 to 5)), age (OR=2.5 (95% CI 2.0 to 3.2)), male gender (OR=1.6 (95% CI 0.98 to 2.6)) and elevated C reactive protein (CRP) levels on admission (OR for a 10 mg/L increase=1.1 (95% CI 1.1 to 1.2)) were independent risk factors for mortality.ConclusionHistory of CVD is associated with higher in-hospital mortality and MACE in hospitalised patients with COVID-19. Other factors associated with higher in-hospital mortality are older age, male sex and elevated CRP on admission.

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Abstract 14: The Influence of Provider Specialty on Anticoagulation Prescription Fills and Stroke Risk in Atrial Fibrillation Patients With History of Cancer

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.14 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Wesley T O’Neal ◽

J’Neka Claxton ◽

Richard MacLehose ◽

Lin Chen ◽

Lindsay G Bengtson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulant ◽

Cox Regression ◽

Prior History ◽

Cancer Type ◽

Patients With Cancer ◽

Increased Risk ◽

History Of ◽

Reduced Risk ◽

History Of Cancer

Background: Early cardiology involvement within 90 days of atrial fibrillation (AF) diagnosis is associated with greater likelihood of oral anticoagulant use and a reduced risk of stroke. Due to variation in cardiovascular care for patients with cancer, it is possible that a similar association does not exist for AF patients with cancer. Methods: We examined the association of early cardiology involvement with oral anticoagulation use among non-valvular AF patients with history of cancer (past or active), using data from 388,045 patients (mean age=68±15 years; 59% male) from the MarketScan database (2009-2014). ICD-9 codes in any position were used to identify cancer diagnosis prior to AF diagnosis. Provider specialty and filled anticoagulant prescriptions 3 months prior to and 6 months after AF diagnosis were obtained. Poisson regression models were used to compute the probability of an oral anticoagulant prescription fill and Cox regression was used to estimate the risk of stroke and major bleeding. Results: A total of 64,016 (17%) AF patients had a prior history of cancer. Cardiology involvement was less likely to occur among patients with history of cancer than those without (relative risk=0.92, 95% confidence interval (0.91, 0.93)). Similar differences were observed for cancers of the colon (0.90 (0.88, 0.92)), lung (0.76 (0.74, 0.78)), pancreas (0.74 (0.69, 0.80)), and hematologic system (0.88 (0.87, 0.90)), while no differences were observed for breast or prostate cancers. Patients with cancer were less likely to fill prescriptions for anticoagulants (0.89 (0.88, 0.90)) than those without cancer, and similar results were observed for cancers of the colon, lung, prostate, pancreas, and hematologic system. However, patients with cancer were more likely to fill prescriptions for anticoagulants (1.48 (1.45, 1.52)) if seen by a cardiology provider, regardless of cancer type. A reduced risk of stroke (hazard ratio=0.89 (0.81, 0.99)) was observed among all cancer patients who were seen by a cardiology provider than among those who were not, without an increased risk of bleeding (1.04 (0.95, 1.13)). Conclusion: AF patients with cancer were less likely to see a cardiologist, and less likely to fill an anticoagulant prescription than AF patients without cancer. However, cardiology involvement was associated with increased anticoagulant prescription fills and reduced risk of stroke, suggesting a beneficial role for cardiology providers to improve outcomes in AF patients with history of cancer.

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