Cancer patients with a CIED were slightly more likely to receive radiotherapy than those without (HR 1.06; 95% CI 1.03-1.10), but experienced significantly higher rates of device-related procedures.
Cohort (n=913,485)
Does the presence of a CIED affect radiotherapy utilization in cancer patients, and does radiotherapy increase CIED-related healthcare utilization?
While the presence of a CIED does not prevent cancer patients from receiving guideline-indicated radiotherapy, radiotherapy significantly increases the burden of CIED-related healthcare utilization, highlighting the need for devices with increased radiation tolerance.
Effect estimate: HR 1.06 (95% CI 1.03-1.10)
Abstract Background Radiotherapy (RT) is an effective treatment for certain malignancies. Patients implanted with cardiovascular implantable electronic devices (CIEDs) indicated for RT require additional considerations in treatment planning, such as device relocation and reprogramming. An increase in CIED radiation tolerance could ameliorate these considerations, however, the current-state implications of CIEDs on RT treatment pathways and healthcare utilization have not been quantified. Purpose To quantify RT utilization in patients with CIEDs, the differential rates of RT utilization between cancer patients with and without CIEDs, and the differential CIED-related healthcare utilization between cancer patients with and without RT. Methods The Optum Clinformatics© 2007-2022 claims database was used to identify patients with CIEDs and cancers treated with RT. RT use and CIED-related actions (device revision, replacement, removal, re-programming, and interrogation), were identified via procedure codes. Cox models were used to compare RT utilization between patients with and without CIEDs, and logistic and Poisson models were used to compare CIED actions between cancer patients with and without RT. All results were adjusted for patient demographics, and cancer and CIED type. Results Three mutually exclusive cohorts were identified: CIED patients with cancer (N=17,314), non-CIED patients with cancer (N=600,460), and CIED patients with no evidence of cancer (N=295,711). During a follow-up of up to 15.2 years after implant, 9.4% of all patients with CIEDs received RT. Among cancer patients, those with CIED were marginally more likely to receive RT the year after diagnosis than those without CIED (adj. HR=1.06, 95% CI 1.03-1.10; Figure 1). CIED patients who received RT had more CIED-related actions compared to those who did not receive RT (device replacement: 3.7% vs 2.5%, p=0.0002; revision: 0.8% vs 0.4%, p=0.0004; device programming/year: 1.0 vs 0.6, p.0001; interrogation/year: 1.0 vs. 0.6, p.0001; Figure 2); this corresponds to a projected 8 additional procedures and 330 additional device checks in 500 CIED patients with cancer. Conclusion Among patients with cancer, CIED patients were as likely to receive RT as those without a CIED, indicating that CIEDs were not an obstacle to guideline-indicated care. CIED patients with RT have an increased use of device-related healthcare utilization, which could be avoided with increased radiation tolerance labeling.Figure 1 Figure 2
Love et al. (Sat,) conducted a cohort in Cancer and cardiac implantable electronic devices (CIEDs) (n=913,485). Presence of CIED vs. No CIED was evaluated on Radiotherapy utilization the year after cancer diagnosis (HR 1.06, 95% CI 1.03-1.10). Cancer patients with a CIED were slightly more likely to receive radiotherapy than those without (HR 1.06; 95% CI 1.03-1.10), but experienced significantly higher rates of device-related procedures.
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