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July 31, 2007Journal of Clinical OncologyOpen Access

Congestive Heart Failure in Older Women Treated With Adjuvant Anthracycline Chemotherapy for Breast Cancer

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Why the study?

Does adjuvant anthracycline chemotherapy increase the risk of congestive heart failure in older women with breast cancer?

Population

43,338 women aged 66 to 80 years diagnosed with stage I to III breast cancer from 1992 to 2002, with no…

Comparison

Adjuvant anthracycline chemotherapy vs Nonanthracycline chemotherapy or no chemotherapy

Design

Cohort

Follow-up

more than 10 years

Authors

MPMary PinderSir Charles Gairdner HospitalZDZhigang DuanThe University of Texas MD Anderson Cancer CenterJGJames S. GoodwinUniversity of North Carolina at Chapel Hill

Discussion

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Implication

Anthracycline exposure may warrant closer cardiac surveillance in women aged 66-70; leaves open whether the association is causal and requires prospective confirmation.

Key Points

  • Evaluate the long-term incidence and clinical predictors of congestive heart failure among older women treated with adjuvant anthracycline chemotherapy for stage I to III breast cancer.
  • Analyzed records from the SEER-Medicare database for 43,338 women aged 66 to 80 years diagnosed with stage I to III breast cancer between 1992 and 2002 who had no baseline congestive heart failure.
  • Estimated cumulative heart failure rates and utilized multivariable Cox regression analysis to evaluate risk factors associated with congestive heart failure over more than 10 years of follow-up.
  • Anthracycline therapy significantly increased congestive heart failure risk in women aged 66 to 70 years compared with other chemotherapy (HR, 1.26; 95% CI, 1.12 to 1.42), but no association was observed in women aged 71 to 80 years.
  • Key independent predictors of heart failure included age (HR, 1.79 per 10 years; 95% CI, 1.66 to 1.93), Black race (HR, 1.40; 95% CI, 1.30 to 1.50), trastuzumab (HR, 1.46; 95% CI, 1.21 to 1.77), diabetes (HR, 1.74; 95% CI, 1.66 to 1.83), coronary artery disease (HR, 1.58; 95% CI, 1.39 to 1.79), and hypertension (HR, 1.45; 95% CI, 1.39 to 1.52).
  • Left-sided radiotherapy did not significantly increase the risk of congestive heart failure (HR, 1.04; 95% CI, 0.98 to 1.11).

Structured PICO

Does adjuvant anthracycline chemotherapy increase the risk of congestive heart failure in older women with breast cancer?

P
Population
43,338 women aged 66 to 80 years diagnosed with stage I to III breast cancer from 1992 to 2002, with no history of congestive heart failure.
I
Intervention
Adjuvant anthracycline chemotherapy
C
Comparator
Nonanthracycline chemotherapy or no chemotherapy
O
Outcome
Development of congestive heart failure (CHF)safety

Adjuvant anthracycline chemotherapy significantly increases the long-term risk of congestive heart failure in older women aged 66 to 70 years with breast cancer.

Cite This Study

Pinder et al. (2007) studied this question.

synapsesocial.com/papers/69ffcb7c7e61d2a3f0c23026https://doi.org/10.1200/jco.2006.10.4976

Topics

Heart failureHFrEF treatment
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