Evaluation of cardiovascular risk factors in women with left breast cancer of middle-aged and elderly age at the stage of chemotherapy and radiotherapy

The study was conducted to identify risk factors for cardiovascular complications in 38 women with HER2neu negative left breast cancer without severe cardiovascular pathology, related both to the clinical features of the patients and the treatmenbeing performed. Patients after radical mastectomy were hospitalized for chemotherapy (doxorubicin in a cumulative dose not exceeding 360 mg/m2) and 3D conformal radiation therapy on the left breast breast of chest radiation doses 39 Gy (equivalent to 48 Gy of normal functioning). Separation into groups was carried out depending on the age: from 20 to 59 years - 20 patients, from 60 to 74 years - 18 patients. It was revealed that the risk of cardiovascular complications in the Score Scale was significantly higher in elderly patients due to age, increased systolic blood pressure and hypercholesterolemia. These patients showed higher rates of BMI and abdominal obesity. The study of psychosocial factors has shown great importance of the transferred stress in the past. The patients of the second group showed high personal anxiety (55.4 ± 3.4, 95% CI 49,6-56,4). In 70% of middle-aged patients and 89% of elderly patients after chemotherapy and radiotherapy cardiotoxicity in the form of cardiac insufficiency of systolic and diastolic dysfunction and asymptomatic cardiac arrhythmias was revealed. (For citation: Vologdina IV, Zhabina RM, Poroshina EG, et al. Evaluation of cardiovascular risk factors in women with left breast cancer of middle-aged and elderly age at the stage of chemotherapy and radiotherapy. Herald of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):33-38. doi: 10.17816/mechnikov201810233-38).

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Age characteristics of risk cardiovascular complications in women with left breast cancer with preserved ejection fraction at the stage of chemotherapy and radiotherapy

Kardiologiia ◽

10.18087/cardio.2573 ◽

2019 ◽

Vol 59 (7S) ◽

pp. 23-30

Author(s):

I. V. Vologdina ◽

R. M. Zhabina

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Ejection Fraction ◽

Elderly Patients ◽

The Elderly ◽

Cardiovascular Complications ◽

Left Breast ◽

Middle Aged ◽

Aged Patients ◽

Score Risk

Aim. A study of the risk factors for middle-aged and elderly women HER2neu with negative left breast cancer and a normal ejection fraction at the stage of chemoradiotherapy in everyday clinical practice. Matherial and methods. 61 women with left breast cancer without severe cardiovascular pathology were examined at the stage of doxorubicin therapy and 3D conformal radiation therapy. Group 1 comprised 32 patients of middle age (49.8 ± 4.5 years). Group 2 comprised 29 elderly patients (68.3 ± 3.6 years). In addition to Score risk assessment, additional factors, including psychosocial factors, were studied. All patients underwent ECG, echocardiography and 24-hour ECG monitoring. Anxiety levels were assessed using the HADS scale and scale CH. D. Spielberger –Yu.L. Khanin. The study was conducted before the start of treatment, after the completion of the doxorubicin course and after the completion of the course of radiotherapy. Results with discussion. In middle-aged patients, moderate Score risk was found in 21.9%, in the elderly at 58.6% (p = 0.0043, RR 2.68, 95% CI 1.301–5.520). A high Score risk was found in 15.6% of middle-aged patients and 41.4% of elderly patients (p = 0.0438, RR 2.648, 95% CI 1061–6.607). The most common risk factors in the patients studied in addition to age were heredity, overweight, hypercholesterolemia and diabetes mellitus. All examined patients had moderate reactive anxiety. Patients of middle age have moderate personal anxiety, in elderly patients high personal anxiety. After treatment with doxorubicin in a cumulative dose not exceeding 360 mg/m2 , a reduction in the ejection fraction below 50% was found in 6 middle-aged patients and 17.2% in elderly patients. Asymptomatic diastolic dysfunction was detected in 31.3% of middle-aged patients and 55.2% of the elderly. In patients of both groups, after arranging treatment, arrhythmia was detected. Conclusions. The obtained data indicate to the need for in-depth examination of middle-aged and especially elderly patients with left breast cancer with an assessment of risk factors and conducting an in-depth examination using Echocardiography, 24-hour ECG monitoring and psychological testing to prevent and early detection of cardiovascular complications.

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Risk factors for cardiovascular complications in patients with left breast cancer in daily clinical practice

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov202012263-70 ◽

2020 ◽

Vol 12 (2) ◽

pp. 63-70

Author(s):

Elena G. Poroshina ◽

Irina V. Vologdina ◽

Razifa M. Zhabina ◽

Andrey A. Stanzhevsky ◽

Larisa A. Krasilnikova

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Risk Factors ◽

Elderly Patients ◽

Healthy Lifestyle ◽

The Elderly ◽

Cardiovascular Complications ◽

Left Breast ◽

Middle Aged ◽

Aged Patients

Purpose. Detection of adherence to a healthy lifestyle (HLS) and evaluation of behavioral risk factors for cardiovascular complications (CVC), including psychosocial, in patients with left breast cancer at the stage of chemoradiotherapy in daily clinical practice. Materials and methods. The patients were hospitalized for 3D conformal radiation therapy on the bed of the left breast with a total radiation dose (TRD) of 39 Gy (equivalent to 48 Gy of conventional fractionation). All the patients had a Madden mastectomy at the previous stages followed by doxorubicin therapy at a cumulative dose not exceeding 360 mg/m2. Determination of all components of a healthy lifestyle was carried out according to the data of interviewing the participants. The risk category of cardiovascular complications was assessed according to the SCORE scale. Additional characteristics including psychosocial factors were assessed. The examination included ECG and echocardiography. Results. At the initial examination, 58% of middle-aged patients and 74% of elderly patients showed comorbidity, while 18% of middle-aged patients and 29% of elderly patients had multiple comorbidities. Low adherence to healthy lifestyle in the patients was primarily associated with low physical activity due to the existing pain syndrome caused by both the tumor process itself and the surgical intervention. Physical activity in both groups was significantly lower than in the general population. High risk of CVC was significantly more common in the elderly patients. Systolic and diastolic dysfunction as a manifestation of cardiotoxicity after the previous stage of doxorubicin therapy were detected in middle-aged patients in 35.7% of the cases, in the elderly patients in 56.5% of the cases (HR 0.643, 95% CI 0.470-0.880). Psychosocial factors such as acute chronic stress and family problems were the most common. All the examined patients showed moderate reactive anxiety. The elderly patients showed a high level of personal anxiety. Conclusions. The obtained data suggest that in breast cancer patients, low adherence to HLS is primarily associated with low physical activity and unhealthy diet and to a much lesser extent smoking, which is of great importance in the formation of a healthy lifestyle in these patients in the future. In elderly patients, the study significantly more often identified risk factors such as obesity, high blood pressure, hypercholesterolemia and hyperglycemia. These patients revealed increased level of personal anxiety. This highlights the need for an expanded study of not only the main but also additional risk factors.

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Prevalence of risk factors of cardiovascular complications in elderly women with left breast cancer

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov201911385-92 ◽

2019 ◽

Vol 11 (3) ◽

pp. 85-92

Author(s):

I. V. Vologdina ◽

E. G. Poroshina ◽

R. M. Zhabina ◽

A. A. Stanzhevsky

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Radiation Therapy ◽

Elderly Patients ◽

Elderly Women ◽

Systolic Dysfunction ◽

Study Groups ◽

Cardiovascular Complications ◽

Left Breast ◽

Aged Patients

The purpose to study the risk factors for elderly women with left breast cancer at the stage of chemotherapy and radiotherapy in the context of daily clinical practice for early detection of possible cardiovascular complications and optimization of therapy. Material and methods. 69 women with HER2 neu negative left breast cancer without severe cardiovascular disease were examined. The first group included 39 elderly patients (67.7 3.8 years). The second group consisted of 34 middle-aged patients (49.8 5.7 years). In addition to the risk assessment according to the Score scale, additional factors including psychosocial factors were studied. The examination was carried out before the start of treatment, after the end of the course of doxorubicin in a cumulative dose of up to 360 mg/m2 and after the completion of radiation therapy 3D conformal radiation therapy SOD 39 Gr. Results. In elderly patients, risk factors such as obesity, increased cholesterol, and hypertension were significantly more common. In both study groups, low physical activity was revealed associated with both cancer itself and the treatment. All examined patients had moderate reactive anxiety on the Spielberger-Hanin scale. Elderly patients showed high level of personal anxiety; the number of points scored 49.3 3.6. According to the Score scale, a moderate risk was detected in 18 (58.1%) and a high risk in 13(41.9%) elderly patients. After doxorubicin treatment asymptomatic systolic dysfunction was detected in 8 (20.5%) patients (decrease in EF50%), 21 (75%) diastolic dysfunction with relaxation slowdown (E/A1). In 9 (23.1%) of the women without reducing the EF fibrotic changes in the myocardium of the left ventricle was revealed. In 8 (20.5%) women a thickening of the pericardial layer was revealed. Conclusion. The findings suggest the need for a personalized approach and assessment of risk factors in patients of different age groups with left breast cancer at the stage of preparation and conduct of chemoradiotherapy. This highlights the need for enhanced history collection and consideration of not only key but also additional risk factors. The results of the study can be used in the work of practical health care institutions for the planning, development, implementation and control of chemoradiography safety in terms of preventing cardiovascular complications.

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