Endometrial cancer survivors may need long-term cardiovascular monitoring

Endometrial cancer survivors are at increased long-term risk for a number of adverse cardiovascular outcomes, results of a large, population-based study suggest.

Even after adjustment for potentially confounding factors, the cohort of 2,648 endometrial cancer survivors in this retrospective study had a “high burden” of cardiovascular events compared with 10,503 age-matched women, according to the investigators.

That finding highlights a need for increased monitoring and risk management for cardiovascular disease in endometrial cancer survivors, potentially for up to 10 years, according to Sean Soisson, a PhD student in the division of public health at the University of Utah, Salt Lake City, and his coinvestigators.

The study, published in the Journal of the National Cancer Institute, is not the first to find associations between endometrial cancer and long-term cardiovascular outcomes. However, many of the previous studies had small sample sizes, relied on patient-reported outcomes, or lacked a comparison group, according to investigators.

The study was based on data from the Surveillance, Epidemiology, and End Results (SEER) Utah Cancer Registry for women diagnosed between 1997 and 2012 with an invasive first primary endometrial cancer. The investigators identified cardiovascular disease diagnoses in those patients based on review of electronic medical records and ambulatory surgery and inpatient data.

Endometrial cancer survivors had elevated risks for hypertension, heart disease, and blood vessel diseases at 1-5 years after diagnosis, and for some diseases, the risk persisted at 5-10 years after diagnosis, the investigators found.

Survivors were about 50% more likely to be diagnosed with cardiac dysrhythmias compared with the general population both at 1-5 years (hazard ratio, 1.55; 99% confidence interval, 1.23-1.97) and 5-10 years (HR, 1.41; 99% CI, 1.06-1.88) after diagnosis, according to reported data.

 

There was a twofold increase in risk of phlebitis, thrombophlebitis, and thromboembolism for survivors (HR, 2.07, 99% CI, 1.57-2.72), and risk remained elevated in the 5- to 10-year time frame (HR, 1.53; 99% CI, 1.08-2.17), data show.

Similar increases in risk were reported for other cardiovascular diseases at 1-5 years, and in some cases also at 5-10 years. Cerebrovascular disease was the only major category where no increased risk was found among endometrial cancer survivors, the investigators said.

Type of cancer treatment also may have influenced risk. Among patients who had endometrial cancer, radiation therapy and chemotherapy both increased risk for cardiovascular disorders versus surgery. Advanced age and obesity may have increased risk, the investigators added.

“Studies that examine risk for long-term cardiovascular outcomes among endometrial cancer survivors are becoming increasingly more critical because of the high overall survival rate among individuals diagnosed with endometrial cancer, the large number of endometrial cancer survivors, the projected increase in the number of endometrial cancer diagnoses, the introduction of more complex therapies, and the high mortality due to cardiovascular disease among endometrial cancer survivors,” the authors wrote.

The National Cancer Institute and other organizations supported the study. The authors had no conflicts of interest to disclose.

SOURCE: Soisson S, et al. J Natl Cancer Inst. 2018 May 8. doi: 10.1093/jnci/djy070.

Endometrial cancer survivors are at increased long-term risk for a number of adverse cardiovascular outcomes, results of a large, population-based study suggest.

Even after adjustment for potentially confounding factors, the cohort of 2,648 endometrial cancer survivors in this retrospective study had a “high burden” of cardiovascular events compared with 10,503 age-matched women, according to the investigators.

That finding highlights a need for increased monitoring and risk management for cardiovascular disease in endometrial cancer survivors, potentially for up to 10 years, according to Sean Soisson, a PhD student in the division of public health at the University of Utah, Salt Lake City, and his coinvestigators.

The study, published in the Journal of the National Cancer Institute, is not the first to find associations between endometrial cancer and long-term cardiovascular outcomes. However, many of the previous studies had small sample sizes, relied on patient-reported outcomes, or lacked a comparison group, according to investigators.

The study was based on data from the Surveillance, Epidemiology, and End Results (SEER) Utah Cancer Registry for women diagnosed between 1997 and 2012 with an invasive first primary endometrial cancer. The investigators identified cardiovascular disease diagnoses in those patients based on review of electronic medical records and ambulatory surgery and inpatient data.

Endometrial cancer survivors had elevated risks for hypertension, heart disease, and blood vessel diseases at 1-5 years after diagnosis, and for some diseases, the risk persisted at 5-10 years after diagnosis, the investigators found.

Survivors were about 50% more likely to be diagnosed with cardiac dysrhythmias compared with the general population both at 1-5 years (hazard ratio, 1.55; 99% confidence interval, 1.23-1.97) and 5-10 years (HR, 1.41; 99% CI, 1.06-1.88) after diagnosis, according to reported data.

 

There was a twofold increase in risk of phlebitis, thrombophlebitis, and thromboembolism for survivors (HR, 2.07, 99% CI, 1.57-2.72), and risk remained elevated in the 5- to 10-year time frame (HR, 1.53; 99% CI, 1.08-2.17), data show.

Similar increases in risk were reported for other cardiovascular diseases at 1-5 years, and in some cases also at 5-10 years. Cerebrovascular disease was the only major category where no increased risk was found among endometrial cancer survivors, the investigators said.

Type of cancer treatment also may have influenced risk. Among patients who had endometrial cancer, radiation therapy and chemotherapy both increased risk for cardiovascular disorders versus surgery. Advanced age and obesity may have increased risk, the investigators added.

“Studies that examine risk for long-term cardiovascular outcomes among endometrial cancer survivors are becoming increasingly more critical because of the high overall survival rate among individuals diagnosed with endometrial cancer, the large number of endometrial cancer survivors, the projected increase in the number of endometrial cancer diagnoses, the introduction of more complex therapies, and the high mortality due to cardiovascular disease among endometrial cancer survivors,” the authors wrote.

The National Cancer Institute and other organizations supported the study. The authors had no conflicts of interest to disclose.

SOURCE: Soisson S, et al. J Natl Cancer Inst. 2018 May 8. doi: 10.1093/jnci/djy070.

Endometrial cancer survivors are at increased long-term risk for a number of adverse cardiovascular outcomes, results of a large, population-based study suggest.

Even after adjustment for potentially confounding factors, the cohort of 2,648 endometrial cancer survivors in this retrospective study had a “high burden” of cardiovascular events compared with 10,503 age-matched women, according to the investigators.

That finding highlights a need for increased monitoring and risk management for cardiovascular disease in endometrial cancer survivors, potentially for up to 10 years, according to Sean Soisson, a PhD student in the division of public health at the University of Utah, Salt Lake City, and his coinvestigators.

The study, published in the Journal of the National Cancer Institute, is not the first to find associations between endometrial cancer and long-term cardiovascular outcomes. However, many of the previous studies had small sample sizes, relied on patient-reported outcomes, or lacked a comparison group, according to investigators.

The study was based on data from the Surveillance, Epidemiology, and End Results (SEER) Utah Cancer Registry for women diagnosed between 1997 and 2012 with an invasive first primary endometrial cancer. The investigators identified cardiovascular disease diagnoses in those patients based on review of electronic medical records and ambulatory surgery and inpatient data.

Endometrial cancer survivors had elevated risks for hypertension, heart disease, and blood vessel diseases at 1-5 years after diagnosis, and for some diseases, the risk persisted at 5-10 years after diagnosis, the investigators found.

Survivors were about 50% more likely to be diagnosed with cardiac dysrhythmias compared with the general population both at 1-5 years (hazard ratio, 1.55; 99% confidence interval, 1.23-1.97) and 5-10 years (HR, 1.41; 99% CI, 1.06-1.88) after diagnosis, according to reported data.

 

There was a twofold increase in risk of phlebitis, thrombophlebitis, and thromboembolism for survivors (HR, 2.07, 99% CI, 1.57-2.72), and risk remained elevated in the 5- to 10-year time frame (HR, 1.53; 99% CI, 1.08-2.17), data show.

Similar increases in risk were reported for other cardiovascular diseases at 1-5 years, and in some cases also at 5-10 years. Cerebrovascular disease was the only major category where no increased risk was found among endometrial cancer survivors, the investigators said.

Type of cancer treatment also may have influenced risk. Among patients who had endometrial cancer, radiation therapy and chemotherapy both increased risk for cardiovascular disorders versus surgery. Advanced age and obesity may have increased risk, the investigators added.

“Studies that examine risk for long-term cardiovascular outcomes among endometrial cancer survivors are becoming increasingly more critical because of the high overall survival rate among individuals diagnosed with endometrial cancer, the large number of endometrial cancer survivors, the projected increase in the number of endometrial cancer diagnoses, the introduction of more complex therapies, and the high mortality due to cardiovascular disease among endometrial cancer survivors,” the authors wrote.

The National Cancer Institute and other organizations supported the study. The authors had no conflicts of interest to disclose.

SOURCE: Soisson S, et al. J Natl Cancer Inst. 2018 May 8. doi: 10.1093/jnci/djy070.