Journal article
Cardiac Adverse Events Associated With Chemo-Radiation Versus Chemotherapy for Resectable Stage III Non-Small-Cell Lung Cancer: A Surveillance, Epidemiology and End Results-Medicare Study
Journal of the American Heart Association, Vol.11(23), e027288
12/01/2022
DOI: 10.1161/JAHA.122.027288
PMCID: PMC9851429
PMID: 36453633
Abstract
BACKGROUND: We compared cardiac outcomes for surgery-eligible patients with stage III non-small-cell lung cancer treated adjuvantly or neoadjuvantly with chemotherapy versus chemo-radiation therapy in the Surveillance, Epidemiology and End Results-Medicare database. METHODS AND RESULTS: Patients were age 66+, had stage IIIA/B resectable non-small-cell lung cancer diagnosed between 2007 and 2015, and received adjuvant or neoadjuvant chemotherapy or chemo-radiation within 121 days of diagnosis. Patients having chemo-radiation and chemotherapy only were propensity-score matched and followed from day 121 to first cardiac outcome, noncardiac death, radiation initiation by patients who received chemotherapy only, fee-for-service enrollment inter-ruption, or December 31, 2016. Cause-specific hazard ratios (HRs) and competing risks subdistribution HRs were estimated. The primary outcome was the first of these severe cardiac events: acute myocardial infarction, other hospitalized ischemic heart disease, hospitalized heart failure, percutaneous coronary intervention/coronary artery bypass graft, cardiac death, or urgent/inpatient care for pericardial disease, conduction abnormality, valve disorder, or ischemic heart disease. With median follow-up of 13 months, 70 of 682 patients who received chemo-radiation (10.26%) and 43 of 682 matched patients who received chemotherapy only (6.30%) developed a severe cardiac event (P=0.008) with median time to first event 5.45 months. Chemo-radiation increased the rate of severe cardiac events (cause-specific HR: 1.62 [95% CI, 1.11– 2.37] and subdistribution HR: 1.41 [95% CI, 0.97– 2.04]). Cancer severity appeared greater among patients who received chemo-radiation (noncardiac death cause-specific HR, 2.53 [95% CI, 1.93– 3.33] and subdistribution HR, 2.52 [95% CI, 1.90– 3.33]). CONCLUSIONS: Adding radiation therapy to chemotherapy is associated with an increased risk of severe cardiac events among patients with resectable stage III non-small-cell lung cancer for whom survival benefit of radiation therapy is unclear.
Details
- Title: Subtitle
- Cardiac Adverse Events Associated With Chemo-Radiation Versus Chemotherapy for Resectable Stage III Non-Small-Cell Lung Cancer: A Surveillance, Epidemiology and End Results-Medicare Study
- Creators
- Emma HerbachMichael A O'RorkeRyan M CarnahanBradley D McDowellBryan AllenIsabella GrumbachBarry LondonBrian J SmithDouglas R SpitzAaron SeamanElizabeth A Chrischilles
- Resource Type
- Journal article
- Publication Details
- Journal of the American Heart Association, Vol.11(23), e027288
- DOI
- 10.1161/JAHA.122.027288
- PMID
- 36453633
- PMCID
- PMC9851429
- NLM abbreviation
- J Am Heart Assoc
- ISSN
- 2047-9980
- eISSN
- 2047-9980
- Language
- English
- Date published
- 12/01/2022
- Academic Unit
- Pharmacy; Pathology; Biostatistics; Nursing; Center for Social Science Innovation; Injury Prevention Research Center; Molecular Physiology and Biophysics; Epidemiology; Cardiovascular Medicine; Radiation Oncology; Fraternal Order of Eagles Diabetes Research Center; General Internal Medicine; Community and Behavioral Health; Holden Comprehensive Cancer Center; Internal Medicine
- Record Identifier
- 9984321959102771
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