Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer

Mary C. Pinder, Zhigang Duan, James Goodwin, Gabriel N. Hortobagyi, Sharon H. Giordano

Research output: Contribution to journalArticle

354 Citations (Scopus)

Abstract

Purpose: Limited data are available on long-term cardiac safety of adjuvant anthracycline chemotherapy in breast cancer patients over age 65 years. We evaluated rates and predictors of congestive heart failure (CHF) in this population. Patients and Methods: We used the Surveillance, Epidemiology, and End Results Medicare database and included women with no history of CHF who were age 66 to 80 years and diagnosed with stage I to III breast cancer from 1992 to 2002. Cumulative rates of CHF were estimated, and multivariable Cox regression analysis was used to determine factors associated with the development of CHF. Results: A total of 43,338 women were included. Anthracycline-treated women were younger, with fewer comorbidities and more advanced disease than women who received nonanthracycline or no chemotherapy (P < .001 for each). The adjusted hazard ratio (HR) for CHF was 1.26(95% CI, 1.12 to 1.42) for women aged 66 to 70 treated with anthracycline compared with other chemotherapy. For women aged 71 to 80, adjuvant chemotherapy type was not associated with CHF. The following baseline characteristics were significant predictors of CHF: 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 treatment (HR, 1.46; 95% CI, 1.21 to 1.77), hypertension (HR, 1.45; 95% CI, 1.39 to 1.52), diabetes (HR, 1.74; 95% CI, 1.66 to 1.83), and coronary artery disease (HR, 1.58; 95% CI, 1.39 to 1.79). Left-sided radiotherapy did not confer an elevated risk of CHF (HR, 1.04; 95% CI, 0.98 to 1.11). Conclusion: Women aged 66 to 70 years who received adjuvant anthracyclines had significantly higher rates of CHF. The difference in rates of CHF continued to increase through more than 10 years of follow-up.

Original languageEnglish (US)
Pages (from-to)3808-3815
Number of pages8
JournalJournal of Clinical Oncology
Volume25
Issue number25
DOIs
StatePublished - Sep 1 2007

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Anthracyclines
Adjuvant Chemotherapy
Heart Failure
Breast Neoplasms
Drug Therapy
Medicare
Comorbidity
Coronary Artery Disease
Epidemiology
Radiotherapy
Regression Analysis
Databases
Hypertension
Safety

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer. / Pinder, Mary C.; Duan, Zhigang; Goodwin, James; Hortobagyi, Gabriel N.; Giordano, Sharon H.

In: Journal of Clinical Oncology, Vol. 25, No. 25, 01.09.2007, p. 3808-3815.

Research output: Contribution to journalArticle

Pinder, Mary C. ; Duan, Zhigang ; Goodwin, James ; Hortobagyi, Gabriel N. ; Giordano, Sharon H. / Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer. In: Journal of Clinical Oncology. 2007 ; Vol. 25, No. 25. pp. 3808-3815.
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abstract = "Purpose: Limited data are available on long-term cardiac safety of adjuvant anthracycline chemotherapy in breast cancer patients over age 65 years. We evaluated rates and predictors of congestive heart failure (CHF) in this population. Patients and Methods: We used the Surveillance, Epidemiology, and End Results Medicare database and included women with no history of CHF who were age 66 to 80 years and diagnosed with stage I to III breast cancer from 1992 to 2002. Cumulative rates of CHF were estimated, and multivariable Cox regression analysis was used to determine factors associated with the development of CHF. Results: A total of 43,338 women were included. Anthracycline-treated women were younger, with fewer comorbidities and more advanced disease than women who received nonanthracycline or no chemotherapy (P < .001 for each). The adjusted hazard ratio (HR) for CHF was 1.26(95{\%} CI, 1.12 to 1.42) for women aged 66 to 70 treated with anthracycline compared with other chemotherapy. For women aged 71 to 80, adjuvant chemotherapy type was not associated with CHF. The following baseline characteristics were significant predictors of CHF: 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 treatment (HR, 1.46; 95{\%} CI, 1.21 to 1.77), hypertension (HR, 1.45; 95{\%} CI, 1.39 to 1.52), diabetes (HR, 1.74; 95{\%} CI, 1.66 to 1.83), and coronary artery disease (HR, 1.58; 95{\%} CI, 1.39 to 1.79). Left-sided radiotherapy did not confer an elevated risk of CHF (HR, 1.04; 95{\%} CI, 0.98 to 1.11). Conclusion: Women aged 66 to 70 years who received adjuvant anthracyclines had significantly higher rates of CHF. The difference in rates of CHF continued to increase through more than 10 years of follow-up.",
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AU - Duan, Zhigang

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AU - Giordano, Sharon H.

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N2 - Purpose: Limited data are available on long-term cardiac safety of adjuvant anthracycline chemotherapy in breast cancer patients over age 65 years. We evaluated rates and predictors of congestive heart failure (CHF) in this population. Patients and Methods: We used the Surveillance, Epidemiology, and End Results Medicare database and included women with no history of CHF who were age 66 to 80 years and diagnosed with stage I to III breast cancer from 1992 to 2002. Cumulative rates of CHF were estimated, and multivariable Cox regression analysis was used to determine factors associated with the development of CHF. Results: A total of 43,338 women were included. Anthracycline-treated women were younger, with fewer comorbidities and more advanced disease than women who received nonanthracycline or no chemotherapy (P < .001 for each). The adjusted hazard ratio (HR) for CHF was 1.26(95% CI, 1.12 to 1.42) for women aged 66 to 70 treated with anthracycline compared with other chemotherapy. For women aged 71 to 80, adjuvant chemotherapy type was not associated with CHF. The following baseline characteristics were significant predictors of CHF: 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 treatment (HR, 1.46; 95% CI, 1.21 to 1.77), hypertension (HR, 1.45; 95% CI, 1.39 to 1.52), diabetes (HR, 1.74; 95% CI, 1.66 to 1.83), and coronary artery disease (HR, 1.58; 95% CI, 1.39 to 1.79). Left-sided radiotherapy did not confer an elevated risk of CHF (HR, 1.04; 95% CI, 0.98 to 1.11). Conclusion: Women aged 66 to 70 years who received adjuvant anthracyclines had significantly higher rates of CHF. The difference in rates of CHF continued to increase through more than 10 years of follow-up.

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