Among patients with major gastrointestinal (GI) cancers, such as colorectal, esophageal, gastric, pancreatic, and hepatocellular cancers, cardiac disease is a significant cause of mortality, according to study findings published in JAMA Network Open.

GI cancers make up 26% of global cancer incidence and 35% of all cancer-related deaths. Although overall and cause-specific mortalities have been linked to diabetes, coffee intake, smoking, and grip strength, risks of cardiac mortality in GI cancers are not well established.

To address to this knowledge gap, a team of researchers conducted a cohort study in the United States using data from the Surveillance, Epidemiology and End Results Registry to analyze mortality rates specific to cardiac outcomes in patients with major GI cancers. Researchers also assessed the association between radiation and chemotherapy with survival outcomes in these patients.


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A total of 359,032 patients (mean age at baseline, 65.1 years; 52.4% men) with major GI cancers were included in the analysis. Of the cohort, 87.4% had colorectal cancer, 2.1% had esophageal cancer, 5.9% had gastric cancer, 2.0% had pancreatic cancer, and 2.6% had hepatocellular cancer.

Among all GI tumors, cardiac-specific disease resulted in a higher mortality compared with other noncardiac mortalities (median survival time, 121 months vs 287 months, respectively). The mean cardiac-specific survival among patients with colorectal cancer was 122 months compared with 287 months for other-cause mortality (P <.001).

Cardiac-mortality results were similar for patients with esophageal cancer compared with other-cause mortality (median survival time, 113 months vs 271 months, respectively; P <.001). Cardiac-specific mortality among patients with gastric cancer was also worse compared with other-cause mortality (median survival time, 113 months vs 278 months, respectively; P <.001).

Patients with pancreatic cancer had the lowest cardiac-specific median survival compared with other-cause mortality (median survival time, 105 months vs 293 months, respectively; P <.001). Although patients with hepatocellular carcinoma had a cardiac-specific median survival of 98 months, the median survival for other-cause mortality could not be recorded, as the majority of patients in this comparison population did not die.

An assessment of survival outcomes at 15 years of follow-up revealed that multimodal therapy with combined chemotherapy and radiation resulted in lower cardiac survival rates and higher noncardiac survival rates.

Using a multivariable Cox proportion analysis, the researchers found that in patients with colorectal cancer, mortality was less likely among women (hazard ratio [HR], 0.68; P <.001), in patients who were Asian or Pacific Islander (HR, 0.64; P <.001), and patients who were treated with combined chemotherapy and surgery (HR, 0.68; P =.01). In contrast, mortality among patients with colorectal cancer was more likely to be associated with increasing age (HR per 1 year increase, 1.12; P <.001) and among patients who were American Indian or Alaska Native (HR, 1.17; P <.001).

“Men were more likely to experience cardiac death compared with women, the authors noted. “Compared with White individuals, American Indian or Alaska Native individuals were most likely to experience cardiac death compared with individuals of other races. These findings are supported by data that show American Indian or Alaska Native individuals are more likely to have higher baseline cardiovascular disease,” they continued.

The authors also noted that, “Further research is needed to discern the mechanisms by which chemotherapy and radiation may exacerbate cardiac disease and methods for reducing risk.”

Reference

Ramai D, Heaton J, Ghidini M, et al. Population-based long-term cardiac-specific mortality among patients with major gastrointestinal cancers. JAMA Netw Open. 2021;4(6):e2112049. doi:10.1001/jamanetworkopen.2021.12049