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- He, Wei, et al.
(författare)
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Concomitant Discontinuation of Cardiovascular Therapy and Adjuvant Hormone Therapy Among Patients With Breast Cancer
- 2023
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Ingår i: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 6:7
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE A large proportion of patients with breast cancer concomitantly use adjuvant hormone therapy and cardiovascular therapy. OBJECTIVE To examine the relative risk of discontinuing cardiovascular therapy during the periods before and after discontinuation of adjuvant hormone therapy. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included all women aged 40 to 74 years in Stockholm, Sweden, who were diagnosed with breast cancer and concomitantly using adjuvant hormone therapy and cardiovascular therapy. Patients were enrolled from July 1, 2005, to August 31, 2020, with a median follow-up of 7.2 years. Data were analyzed from November 3, 2021, to May 12, 2022. EXPOSURE Discontinuation of adjuvant hormone therapy. MAIN OUTCOMES AND MEASURES The main outcome was discontinuation of cardiovascular therapy (cardiovascular drugs, statins, or aspirin) within 1 year before and after discontinuation of adjuvant hormone therapy. Incidence rate ratios with 95% CIs were estimated using Poisson regression. Furthermore, hazard ratios (HRs) with 95% CIs for cause-specific mortality were estimated using Cox proportional hazards regression models, comparing those who discontinued and continued adjuvant hormone therapy. RESULTS A total of 5493 patients with breast cancer who concomitantly used cardiovascular therapy were identified; 1811 who discontinued adjuvant hormone therapy were individually matched to 1 patient each who continued therapy by year of breast cancer diagnosis, age at diagnosis, and use of the same cardiovascular therapy. Most patients (4070 [74.1%]) were aged 60 years or older at diagnosis. At the time when patients discontinued adjuvant hormone therapy, 248 (12.2%) concomitantly discontinued their cardiovascular therapy. During follow-up, a higher discontinuation rate of cardiovascular therapy was also observed among those who discontinued adjuvant hormone therapy. Consistently, adjuvant hormone therapy discontinuation was associated with an increased risk of death not only due to breast cancer (HR, 1.43; 95 CI%, 1.01-2.01) but also cardiovascular disease (HR, 1.79; 95 CI%, 1.15-2.81). Stratifying the analyses on baseline type of adjuvant hormone therapy yielded consistent results. CONCLUSIONS AND RELEVANCE In this cohort study of data from population-based registers in Sweden, patients who discontinued adjuvant hormone therapy were also more likely to discontinue cardiovascular therapy, especially at the time when they discontinued adjuvant hormone therapy. These findings suggest that clinicians should shift from single- to multiple-disease focus to prevent discontinuation of therapies for other diseases among patients with breast cancer.
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| 2. |
- Yang, Haomin, et al.
(författare)
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Risk of heart disease following treatment for breast cancer - results from a population-based cohort study
- 2022
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Ingår i: eLIFE. - : eLife Sciences Publications Ltd. - 2050-084X. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients. This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure, and ischemic heart disease in women diagnosed with breast cancer.Methods: A register-based matched cohort study was conducted including 8015 breast cancer patients diagnosed from 2001 to 2008 in the Stockholm-Gotland region and followed up until 2017. Time-dependent risks of arrhythmia, heart failure, and ischemic heart disease in breast cancer patients were assessed using flexible parametric models as compared to matched controls from general population. Treatment-specific effects were estimated in breast cancer patients using Cox model.Results: Time-dependent analyses revealed long-term increased risks of arrhythmia and heart failure following breast cancer diagnosis. Hazard ratios (HRs) within the first year of diagnosis were 2.14 (95% CI = 1.63-2.81) for arrhythmia and 2.71 (95% CI = 1.70-4.33) for heart failure. HR more than 10 years following diagnosis was 1.42 (95% CI = 1.21-1.67) for arrhythmia and 1.28 (95% CI = 1.03-1.59) for heart failure. The risk for ischemic heart disease was significantly increased only during the first year after diagnosis (HR = 1.45, 95% CI = 1.03-2.04). Trastuzumab and anthracyclines were associated with increased risk of heart failure. Aromatase inhibitors, but not tamoxifen, were associated with risk of ischemic heart disease. No increased risk of heart disease was identified following locoregional radiotherapy.Conclusions: Administration of systemic adjuvant therapies appears to be associated with increased risks of heart disease. The risk estimates observed in this study may aid adjuvant therapy decision-making and patient counseling in oncology practices.
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| 3. |
- Zeng, Erwei
(författare)
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Adjuvant hormone therapy in breast cancer patients : a special focus on treatment discontinuation
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: Breast cancer is the most common cancer among women, with approximately 80% of cases being estrogen-receptor (ER) positive. Adjuvant hormone therapy is a standard treatment that is recommended for ER-positive patients for a minimum of five years, but many patients discontinued it prematurely. ER-positive breast cancer also carries a risk of late recurrence, which may necessitate the use of adjuvant hormone therapy for up to ten years. This doctoral project aims to investigate the use of adjuvant hormone therapy in a real-world setting and provide insights to enhance clinical practice and patient outcomes. Patients and Methods: Four observational studies were conducted using data from multiple Swedish health registers. The study population comprised all women diagnosed with ER-positive breast cancer who initiated adjuvant hormone therapy in the Stockholm-Gotland region. Studies I-III examined the association between patient, family, and comedication factors with the adjuvant hormone therapy discontinuation and breast cancer prognosis. Study IV assessed the real-world use and outcomes of extending adjuvant hormone therapy beyond five years. Findings: Study I showed that hot flashes related to adjuvant hormone therapy predicted worse outcomes and discontinuation, which contrasted with findings from clinical trials. This discrepancy may be attributed to the variation in discontinuation rates between clinical practice and trials. Study II demonstrated that experiencing familial adversity, including material deprivation, negative dynamics, and loss or threat of loss of family member, also contributed to treatment discontinuation and mortality. Study III identified that discontinuation of adjuvant hormone and cardiovascular therapies often occurred concomitantly, underscoring the need for an integrated cardio-oncology approach. Finally, Study IV showed that extending adjuvant therapy beyond five years improved breast cancer outcomes in clinical practice. Conclusions: In conclusion, the findings of this thesis emphasize the importance of continuous support for patients undergoing adjuvant hormone therapy. Additionally, the extended use of adjuvant hormone therapy beyond five years may be necessary to improve long-term breast cancer outcomes.
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