Key result
Frail breast cancer patients receiving adjuvant therapy had a higher risk of adverse cardiovascular events compared with robust patients (adjusted sHR 1.70; 95% CI 1.11-2.61; P=0.015).
Why the study?
Prior research suggested breast cancer patients with high frailty may face increased cardiotoxicity risk, prompting evaluation of this association during adjuvant therapy after surgery.
Does pre-existing frailty increase the risk of cardiotoxicity in female breast cancer patients receiving adjuvant therapy?
Cohort (n=2,050)
Yes
Does pre-existing frailty increase the risk of cardiotoxicity in female breast cancer patients receiving adjuvant therapy?
Hazard Ratio: 1.7 (95% CI 1.11–2.61)
Absolute Event Rate: 29.4% vs 17.8%
p-value: p=0.015
Pre-existing frailty is significantly associated with an increased risk of cardiotoxicity in female breast cancer patients receiving adjuvant therapy, highlighting the need for enhanced cardiovascular monitoring in this vulnerable subgroup.
Frailty may identify higher-risk patients for cardiotoxicity monitoring; hypothesis-generating and leaves open whether modification alters outcomes.
BACKGROUND: Prior research suggests that breast cancer patients with a high burden of frailty may face an increased risk of cardiotoxicity. OBJECTIVES: This study sought to examine the association between frailty and cardiotoxicity rates in female breast cancer patients receiving adjuvant therapy after surgery. METHODS: We analyzed data from the OneFlorida+ clinical research network, focusing on breast cancer patients treated with adjuvant chemotherapy and targeted therapy from 2012 to 2022. Cardiovascular rates during adjuvant treatments were calculated based on pre-existing frailty, measured using the cumulative deficit frailty index (electronic health record frailty index). We employed multivariable Gray's method to examine the association between frailty with cardiotoxicity. RESULTS: The final cohort included 2,050 patients (mean age 50.6 years), with 415 (20.2%) experiencing nonfatal adverse cardiovascular events after adjuvant therapy. The incidence of adverse cardiovascular events was 17.8% in robust, 23.2% in prefrail, and 29.4% in frail patients. In multivariable analysis, prefrail (adjusted subdistribution HR [sHR]: 1.35; 95% CI: 1.06-1.71; P = 0.015) and frail (adjusted sHR: 1.70; 95% CI: 1.11-2.61; P = 0.015) patients had a higher likelihood of experiencing adverse cardiovascular events compared with robust patients. Among non-Hispanic White and Black patients, prefrail (adjusted sHR: 1.48; 95% CI: 1.04-2.11; P = 0.031; and adjusted sHR: 1.59; 95% CI: 1.06-2.37; P = 0.024, respectively) and frail (adjusted sHR: 1.96; 95% CI: 1.10-3.50; P = 0.022; and adjusted sHR: 2.13; 95% CI: 1.11-4.10; P = 0.023, respectively) patients were more likely to experience adverse cardiovascular events compared with robust patients. No significant differences were observed in other racial/ethnic groups. CONCLUSIONS: These findings highlight the need for close monitoring of cardiotoxicity in frail breast cancer patients undergoing adjuvant treatments to improve cardiovascular risk management.
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Yang et al. (2025) conducted a cohort in Breast cancer (n=2,050). Frailty vs. Robust was evaluated on Adverse cardiovascular events (sHR 1.70, 95% CI 1.11-2.61, p=0.015). Frail breast cancer patients receiving adjuvant therapy had a higher risk of adverse cardiovascular events compared with robust patients (adjusted sHR 1.70; 95% CI 1.11-2.61; P=0.015).
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