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e13624
Background: Breast cancer is the most common malignancy in females. Early detection and advances in treatment modalities have resulted in decreasing rates of breast cancer ...related death. While breast cancer survival has improved, risks of death from cardiovascular comorbidities have increased. Our study aims to evaluate survival among breast cancer patients with cardiac comorbidities. Methods: This study was conducted using a retrospective cohort design with use of de-identified hospital electronic patient records. ICD diagnoses codes were used to identify breast cancer patients. Our initial search criteria revealed 1618 patients. Our eligibility criteria included adult patients 18 years and older with newly diagnosed breast cancer from January 1
st
, 2014 – January 31
st
, 2017 which yielded 478 patients. All data was collected through retrospective chart review. Analysis was performed with SAS v9.4 software. Qualitative variables were analyzed using Chi-Square Test. Survival curves are estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival are assessed with Cox proportional hazards regression analyses. All significance was assumed at the p < 0.05 level and reported as hazard ratios (HR). Results: Of our 478 patients, the following comorbidities were noted: diabetes n = 98 (21.17%), myocardial infarction (MI) n = 14 (2.98%), heart failure (HF) n = 36 (8.38%), coronary artery disease (CAD) n = 26 (5.75%), hypertension (HTN) n = 261 (55.77%), peripheral vascular disease (PVD) n = 9 (1.95%), hyperlipidemia (HLD) n = 230 (49.15%). Survival analysis was completed on patients with CAD (p = 0.49), HLD (p = 0.40), HTN (p = 0.15), MI (p = 0.52), and HF HR = 6.35 (95% CI 2.40-16.7, p = 0.0002). Pre-existing HF had a higher risk of mortality, which was statistically significant; however, all other single comorbidities were not. Overall survival (OS) in patients with more than one comorbidity HR = 1.36 (1.08-1.69, p = 0.006), was statistically significant. Conclusions: Patients with only one comorbidity be it MI, CAD, HTN, HLD did not have statistically significant results in OS. However, breast cancer patients with pre-existing HF are at 6.35-fold higher risk of mortality than those without HF. Patients with more than one comorbidity listed above were at 1.36-fold higher risk of mortality. Our results indicate that risk factor reduction may help improve survival in patients with breast cancer. Prospective validation of these findings is warranted.
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e13631
Background: Breast cancer is the most common female malignancy. In 2019, it is estimated that there were 268,000 new cases of female breast cancer. The most common subtype was ...HR+/HER2 based on 2012-2016 cases, a much higher rate than triple negative breast cancer. Best survival rates are found among women with HR+/HER2- subtype followed by HR+/HER2+ and HR-/HER+ subtypes. Triple negative subtype comparatively had a poorer survival.Our objective was to determine breast cancer rate and survival by molecular subtype in the central Illinois population. Methods: A cohort of 478 patients diagnosed with breast cancer between January 2014 and December 2017 was identified by using ICD codes. Eligibility criteria included pathology confirmed breast cancer.Categorical variables were summarized as frequencies and percentages. Predictors of survival were assessed with Cox proportional hazards regression analyses.All significance was assumed at the p < 0.05 level. Results: Luminal A breast cancer was the most common type in our population. In the cohort of 478 patients, 208 patients (74%) were found to have Luminal A. whereas, 37 patients (13.21%) had Basal subtype, 20 patients (7.14%) had Luminal B and 13 patients (5.36%) had Her2 enriched subtype. However, there was no statistical difference in survival between the subtypes. Conclusions: Although the frequency of cancer subtypes in our population is comparable to the national epidemiology data,we observed that there is no statistical difference in survival as compared to NCI SEERS data. This could be due to optimum care and patient’s adherence to chemo-radiation or due to small sample size. This could be an important area of future research to investigate if we can increase survival of poor prognosis subtypes (as triple negative) by following the same measures. Long term follow up for the patients in the study might also be necessary.
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e12540
Background: Cardiovascular disease is one of the leading causes of deaths in breast cancer patients. Pre-existing cardiac conditions and cardiovascular risks associated with ...chemotherapy affect the overall mortality of these patients. Cardio protective medications like beta-blocker, ACEIs, ARBs, statin, and potassium-sparing diuretics have shown to increase the survival odds. In our study, we investigated the survival of breast cancer patients who were on cardio protective medications. Methods: Our retrospective cohort study included breast cancer patients from Simmons Cancer Institute, Springfield, Illinois from January 1
st
, 2014 to December 31
st
, 2017. The first step comprised of screening patients using ICD code of breast cancer. Next, a retrospective chart review led to selecting eligible patients with biopsy proven breast cancer diagnosis within the aforementioned dates. We excluded patients who were diagnosed outside the give time frame. Data on age, gender, medical comorbidities, medications, and survival status were also collected. Comparisons between categorical variables were compared with the Chi-Squared test. Survival curves were estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival are assessed with Cox proportional hazards regression analyses. Results: Screening using ICD codes resulted in 1618 patients. Of those, 478 had biopsy proven diagnosis within the dates mentioned. 301 out of 478 patients were on some kind of cardio protective medication (88 on beta-blockers, 73 on ACEIs, 41 on ARBs, 87 on statins, and 12 on potassium sparing diuretics). We looked into survival analysis in patients on different cardioprotective medications. ARBs and potassium sparing diuretics showed increased likelihood of survival as the hazard ratio (HR) was found to be 0.512 (95% Cl: 0.068-3.832, p-value:0.0919) and HR 0.390 (95% CI: 0.130-1.66, p-value:0.514) respectively. In contrast, other cardio protective medications showed decreased trends for survival. The HR of beta blocker was 1.734 (95% CI: 0.508-5.919, p-value: 0.379) and of ACEIs was 1.350 (95% CI: 0.395-4.613, p-value: 0.632). Similarly, statins had a hazard ratio of 1.534 (95% CI: 0.512- 4.594, p-value:0. 444). Conclusions: We found that the cardio protective medications showed no statistically significant difference in survival in breast cancer patients. Given the smaller sample size and single center study, further multi-center clinical trial is warranted to establish a stronger association.
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e12548
Background: Chemotherapy-induced cardiotoxicity has been associated with certain breast cancer therapy regimens, such as anthracyclines. With the development of newer therapies, ...just as the anti HER2 agents,another association with cardiotoxicity has been recognized in these drug groups. We report the cardiac safety of anti-HER2 agents and anthracyclines. Methods: A retrospective chart review was conducted of patients diagnosed with breast cancer between January 1st 2014 and December 31st 2017, treated with chemotherapy were identified from a large cancer center database. Heart failure, ACS, and other comorbidities were identified using billing codes. Primary outcome was cardiac event,defined by New York Heart Association class II, III or IV heart failure, ACS and heart failure hospitalization. Fisher's exact test was used to test associations between medication categories and cardiac events. Results: A total of 478 patients were included in our study.Our results indicated a significant association of anti HER2 agents with new heart failure with 12.24% (6/49) of patients, compared to 4.04% (12/297) in the control group (p = 0.0288). For the compound of all cardiac events, patients on the anti HER2 arm did not have a significant association, representing 12.50%(6/48) (p = 0.117).Regarding anthracyclines, results demonstrated a significant association of cardiac events, with an incidence of 17.46%(11/63) compared to 4.59%(14/305) in the control group (p = 0.001). We also found that specifically for new onset heart failure, the anthracycline group had a proportion of 13.64%(9/66), in comparison to the control group which had an incidence of 3.21%(9/280) (p = 0.0023). Conclusions: These findings are comparable to rates reported in studies evaluating cardiac safety of anthracyclines and anti-HER2 agents,calling attention to the importance of novel techniques and treatments for the management of chemotherapy-induced cardiotoxicity.
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e13622
Background: Breast cancer is the most prevalent malignancy affecting the female population in the United States and poses a significant mortality risk. In central Illinois, our ...objective was to analyze cardiac events (described as a new diagnosis of heart failure, heart failure hospitalizations, and acute coronary syndrome) in patients diagnosed with breast cancer and overall survival. Methods: A retrospective analysis completed in February 2020 identified patients (n = 1618) based on ICD diagnosis codes with a primary diagnosis of breast cancer. The inclusion criteria comprised of confirmed pathology report with diagnosis of breast cancer between January 2014 and December 2017. A cohort of 478 patients was identified as having met the inclusion criteria. Baseline characteristics and qualitative information were obtained from retrospective chart review. Continuous variables were described with measures of central tendency (mean, median) and dispersion (range, standard deviation). Categorical variables were summarized as frequencies and percentages. Furthermore, comparison between categorical variables were analyzed using Chi-Square test. Survival curves were estimated using kaplan-meier methodology and analyzed with a log rank test. Qualitative variables were analyzed using chi-square test and reported as hazard ratio using SAS software. All significance was assumed at the p < 0.05 level. Results: Of the 478 patients that were included as part of the analysis, 425 (89.6%) were of caucasian background and 49 (10.34%) were minorities (Asian, African American, and Hispanic). In regards to heart failure, our data demonstrated increased heart failure hospitalizations in minorities (7.89%) compared to caucasians (1.22%) which was a significant association (p = 0.026). In the overall survival among caucasian and minority groups there was no statistically significant difference (hazard ratio 0.939 with a 95% CI between 0.218-4.048), however it showed slight trend suggesting improved survival in the caucasian population. Conclusions: Our data illustrates that minorities with breast cancer experienced a higher incidence of heart failure when compared to the caucasian population. This supports closer observation at cardiac risk factors of such patients and medical optimization in an effort to prevent cardiac complications. While we did not see a significant difference in overall survival, further studies may be warranted in such population.
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e12616
Background: The most common female malignancy diagnosed in the US is breast cancer. Early breast cancer therapy is often treated with radiation therapy; one of the unfortunate ...side effects of radiotherapy in the past has been cardiotoxicity, especially coronary artery disease. Recent usage of dose reduction techniques have helped reduce these effects. Here, we present our analysis of breast cancer patients that received radiation therapy and the likelihood of cardiotoxicity. Methods: An IRB-approved retrospective study was performed utilizing ICD codes to analyze patients diagnosed with biopsy-confirmed breast cancer between January 1, 2014 and December 31, 2017. 478 of 1618 de-identified patients qualified for this study. Statistical analysis was performed with SAS v9.4. Descriptive statistics were computed for all study variables. Continuous variables were described with measures of central tendency (mean, median) and dispersion (range, standard deviation). Categorical variables were summarized as frequencies and percentages. Comparisons between categorical variables were compared with the Chi-Square test (or Fisher’s Exact) where appropriate. Survival curves were estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival were assessed with Cox proportional hazards regression analyses. All significance is assumed at the p < 0.05 level. Results: Of the 478 eligible patients, heart failure (HF), HF hospitalizations, acute coronary syndrome and overall cardiac events were compared among breast cancer patients. Patients who received radiation experienced HF 6.02% compared to 4.61% without radiation (p = 0.574). HF hospitalization was recorded as 2.27% in radiotherapy compared to 1.23% in non-radiotherapy patients (p = 0.686). Patients who radiation experienced ACS 2.27% of the time as compared to 1.21% in patients who were not treated with radiation. Of note, 9.25% receiving radiation experienced cardiac events compared to 4.24% in patients without radiation (p = 0.068). While results were not statistically significant, the trend of elevated cardiac events in breast cancer patients receiving radiation is noteworthy. Conclusions: Per our study, although statistically insignificant, radiation therapy may result in higher incidence of cardiac events in breast cancer patients. Further large-scale, prospective studies should be performed to confirm the aforementioned trends with respect to survival outcomes in urban and rural populations.
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e12549
Background: Breast cancer remains the number one threat to women’s health while cardiovascular disease (CVD) continues to be the leading cause of mortality in women worldwide. ...Adjuvant therapy with endocrine therapies (selective estrogen receptor modulators (SERM), estrogen receptor blockers (ERB), and aromatase inhibitors (AI) although known to reduce the recurrence of breast cancer in hormone receptor positive breast cancer patients, raise a concern for increased risk of cardiovascular disease. Our study aims to examine breast cancer survival outcomes on patients receiving endocrine therapy who have pre-existing CVD including heart failure. Methods: An institutional database of 478 patients with histologically confirmed hormone receptor positive breast cancer diagnosed between 01/01/2014 to 12/31/2017 was reviewed after IRB approval. Preexisting CVD included coronary artery disease (CAD), history of myocardial infarction (MI), and prior diagnosis of heart failure (HF). Patients were divided in groups depending on treatment with endocrine therapy and underlying CVD. Statistical analysis was performed with SAS v9.4. software. Survival curves were estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival were assessed with Cox proportional hazards regression analyses. All significance was assumed at the p < 0.05 level. Results: Of 478 patients who met the inclusion criteria, 336 (70%) patients were postmenopausal. Out of those 336 patients, 62.2 % (n = 209) received at least one of the endocrine therapies consisting of AI, SERM or an ERB. Of these patients, 2.9 % (n = 6), 9.6% (n = 20) and 5.7% (n = 12) had a significant medical history of underlying MI, HF and CAD, respectively. Survival analysis was performed on 80% (n = 168) patients of the 209 patients with 2.3% (n = 4), 8.9% (n = 15) and 5.2% (n = 11) with underlying MI, HF and CAD respectively. There was no statistically significant difference in survival in these postmenopausal women who received endocrine therapy despite preexisting cardiovascular disease (HR 3; 95% CI, 0.5-16, p > 0.05). Conclusions: A commonly known toxicity related to the adjuvant therapy including endocrine therapy of breast cancer is cardiac toxicity. Patients with history of CVD might be at the highest risk for such toxicity. Our finding is reassuring that endocrine therapy in patients with preexisting CVD including heart failure did not result in reduced survival for our patient cohort.
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e13635
Background: Approximately 40% of females over the age of 65 are newly diagnosed with breast cancer. When considering elderly patients with breast cancer ( > 65 years old), ...complex decision making is required as patients have multiple cardiac comorbidities that may confound treatment goals. In this abstract, we aim to identify survival and cardiac outcomes in elderly individuals. Methods: This study was conducted using a retrospective cohort design with use electronic patient records. ICD diagnoses codes were used to identify breast cancer patients. Our initial search criteria revealed 1618 patients. Our eligibility criteria included adult patients 18 years and older with newly diagnosed breast cancer from January 1
st
, 2014 – January 31
st
, 2017 which yielded 478 patients. All data was collected through retrospective chart review. Analysis was performed with SAS v9.4 software. Qualitative variables were analyzed using Chi-Square Test. Survival curves are estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival are assessed with Cox proportional hazards regression analyses. All significance was assumed at the p < 0.05 level and reported as hazard ratios (HR). Results: Of our 478 breast cancer patients, 260 (59.5%) patients were less than age 65 and 177 (40.5%) patients were older than age 65. Of these two age groups, cardiac events including new diagnosis of heart failure (HF), heart failure (HF) hospitalization, and acute coronary syndrome were studied. For patients with age less than 65: n = 11 for new diagnoses of HF, n = 4 for HF hospitalizations, and n = 3 for ACS. For patients with age greater than 65: n = 5 for new diagnoses of HF, n = 3 for HF hospitalizations, and n = 2 for ACS. Comparing these two groups, there was no statistically significant cardiac event (p = > 0.05). Comparing survival among these two age groups also did not yield statistically significant results (p > 0.05). Conclusions: Per our data, it appears that there is no statistically significant difference in cardiac outcomes in different age groups for patients with breast cancer. Additionally, there was no difference in mortality among different age groups with breast cancer patients. Further prospective studies should be performed to confirm trends of mortality.
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e13620
Background: Breast cancer is the most common female malignancy diagnosed in the US. According to the CDC and WWAMI Rural Health Research Center, rural areas have a lower ...incidence of cancer than urban areas, yet have higher breast cancer related death rates (1,2). Adverse cardiac outcomes may contribute to decreased survival in rural populations. In this abstract, we discuss how environment impacts survival and cardiac outcomes in patients with breast cancer. Methods: An IRB-approved retrospective study was performed utilizing ICD codes to analyze patients diagnosed with biopsy-confirmed breast cancer between January 1, 2014 and December 31, 2017. 478 of 1618 de-identified patients qualified for this study. Statistical analysis was performed with SAS v9.4. Descriptive statistics were computed for all study variables. Continuous variables were described with measures of central tendency (mean, median) and dispersion (range, standard deviation). Categorical variables were summarized as frequencies and percentages. Comparisons between categorical variables were compared with the Chi-Square test (or Fisher’s Exact) where appropriate. Survival curves were estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival were assessed with Cox proportional hazards regression analyses. All significance is assumed at the p < 0.05 level. Results: Of 478 eligible patients, the calculated HR was 0.323 with 95% CI between 0.074 and 1.397 (p = 0.130), suggesting greater likelihood of survival in the urban population as compared to the rural population. Cardiac events like heart failure and ACS resulted in Fisher’s Exact p-value of 1, suggesting no significant difference in cardiac outcomes between the two populations. While results were not statistically significant, the trend of decreased survival in the rural population is noteworthy. Conclusions: Per our study, urban populations may have higher propensity for survival as compared to rural populations. There was no statistically significant difference in cardiac events among the two different population. Socioeconomic factors may play a large role in improved survival outcomes in the urban population, which may include but are not limited to travel to/from appointments and cost of medical care. Further large-scale, prospective studies should be performed to confirm the aforementioned trends with respect to survival outcomes in urban and rural populations.
A recent meta-analysis of 14 clinical trials indicated that daily compared with intermittent iron supplementation resulted in significantly greater hematological improvement in pregnant women. No ...such definitive beneficial effect was demonstrated in preschool children. We compared the efficacy of daily and twice weekly iron supplementation for 6 wk under supervised and unsupervised conditions in the treatment of mild and moderate anemia hemoglobin (Hb) 50–109 g/L in children aged 2–59 mo living in a malaria-endemic area of western Kenya. The study was a cluster-randomized trial using a factorial design; participants were aware of the treatment assigned. All children (n = 1049) were administered a single dose of sulfadoxine-pyrimethamine at enrollment followed by 6 wk of daily supervised iron supplementation 3–6 mg/(kg · d), twice weekly supervised iron supplementation 6–12 mg/(kg · wk), daily unsupervised iron supplementation, or twice weekly unsupervised iron supplementation. In the supervised groups, Hb concentrations at 6 and 12 wk (6 wk postsupplementation) were significantly higher in children given iron daily rather than twice weekly mean (95% CI) difference at 6-wk: 4.2 g/L (2.1, 6.4); 12-wk: 4.4 g/L (1.8, 7.0). Among the unsupervised groups, Hb concentrations were not different at 6 wk mean (95% CI) difference: 0.86 g/L (−1.4, 3.1), but significantly higher at 12 wk for those assigned daily iron mean (95% CI) difference: 3.4 g/L (0.79, 6.0), P = 0.02. In this malarious area and after initial antimalarial treatment, 6 wk of daily iron supplementation results in better hematological responses than twice weekly iron supplementation in the treatment of anemia in preschool children, regardless of whether adherence can be ensured.
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