TY - JOUR
T1 - Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy
T2 - Application of the Framingham Risk Score
AU - Platinum Study Group
AU - Feldman, Darren R.
AU - Ardeshir-Rouhani-Fard, Shirin
AU - Monahan, Patrick
AU - Sesso, Howard D.
AU - Fung, Chunkit
AU - Williams, Annalynn M.
AU - Hamilton, Robert J.
AU - Vaughn, David J.
AU - Beard, Clair J.
AU - Cook, Ryan
AU - Zaid, Mohammad Abu
AU - Lipshultz, Steven E.
AU - Einhorn, Lawrence H.
AU - Oeffinger, Kevin C.
AU - Travis, Lois B.
AU - Fossa, Sophie D.
AU - Curreri, Stephanie
AU - Brames, Mary Jacqueline
AU - Norton, Kelli
AU - Jacobsen, Erin
AU - Silber, Deborah
AU - Anson-Cartwright, Lynn
AU - Cox, Nancy J.
AU - Dolan, M. Eileen
AU - Jacobs, Linda
AU - Panzer, Sarah Lena
AU - Pucci, Donna
AU - Baker, Debbie
AU - Casaceli, Cindy
AU - Johnson, Eileen
AU - Sahasrabudhe, Deepak
AU - Frisina, Robert D.
AU - Bosl, George
AU - Gospodarowicz, Mary
AU - Robison, Leslie L.
N1 - Funding Information:
This work was supported directly by the National Cancer Institute ( 1R01 CA157823 to LBT) and also by Memorial Sloan Kettering Cancer Center Support Grant/Core Grant ( P30 CA008748 ). The authors have stated that they have no conflicts of interest.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Testicular cancer survivors are at increased risk of cardiovascular disease after cisplatin-based chemotherapy. Among 787 testicular cancer survivors, the Framingham Risk Score for cardiovascular disease was elevated among less educated and less vigorously active patients, but did not differ by chemotherapy regimen (4 cycles of EP [etoposide and cisplatin] or 3-4 cycles of BEP [bleomycin, etoposide, and cisplatin]). Follow-up and counseling in high-risk subgroups is recommended. Background: Testicular cancer survivors (TCSs) are at increased risk of cardiovascular disease (CVD) after cisplatin-based chemotherapy (CBCT). Identifying at-risk survivors would allow early intervention, but risk prediction tools such as the Framingham Risk Score (FRS) have not been applied to TCSs given modern chemotherapy. Methods: TCSs > 1 year post-CBCT were evaluated. Associations between FRS and clinical, socioeconomic, and lifestyle measures and treatment regimen (4 cycles, etoposide and cisplatin [EP × 4]); 3 or 4 cycles, bleomycin plus EP (BEP × 3, BEP × 4) were analyzed with general linear multivariable models. Controls from the National Health and Nutrition Examination Survey were matched 1:1 to TCSs by age, race, and education with differences in mean FRS evaluated with 2-sided t tests. Results: Of 787 TCSs (median age, 37.3 years; median follow-up, 4.2 years), 284, 342, and 161 received EP × 4, BEP × 3, or BEP × 4, respectively. TCSs had higher median systolic blood pressure (126 vs. 119 mm Hg; P <.001), but fewer were smokers (8.4% vs. 28.2%; P <.001) than controls. In multivariable analysis, no significant differences in FRS between EP × 4, BEP × 3, and BEP × 4 were observed, but less than college education (P <.001) and lack of vigorous exercise (P =.006) were associated with higher FRS. Mean FRS did not differ between TCSs and controls (6.8% vs. 7.3%; P =.67). Conclusion: This is the first study to apply the office-based FRS to TCSs. Chemotherapy regimen (BEP × 3 vs. EP × 4) was not associated with FRS, but less educated and less vigorously active patients had higher FRS, and present a high-risk subgroup for intense follow-up and counseling.
AB - Testicular cancer survivors are at increased risk of cardiovascular disease after cisplatin-based chemotherapy. Among 787 testicular cancer survivors, the Framingham Risk Score for cardiovascular disease was elevated among less educated and less vigorously active patients, but did not differ by chemotherapy regimen (4 cycles of EP [etoposide and cisplatin] or 3-4 cycles of BEP [bleomycin, etoposide, and cisplatin]). Follow-up and counseling in high-risk subgroups is recommended. Background: Testicular cancer survivors (TCSs) are at increased risk of cardiovascular disease (CVD) after cisplatin-based chemotherapy (CBCT). Identifying at-risk survivors would allow early intervention, but risk prediction tools such as the Framingham Risk Score (FRS) have not been applied to TCSs given modern chemotherapy. Methods: TCSs > 1 year post-CBCT were evaluated. Associations between FRS and clinical, socioeconomic, and lifestyle measures and treatment regimen (4 cycles, etoposide and cisplatin [EP × 4]); 3 or 4 cycles, bleomycin plus EP (BEP × 3, BEP × 4) were analyzed with general linear multivariable models. Controls from the National Health and Nutrition Examination Survey were matched 1:1 to TCSs by age, race, and education with differences in mean FRS evaluated with 2-sided t tests. Results: Of 787 TCSs (median age, 37.3 years; median follow-up, 4.2 years), 284, 342, and 161 received EP × 4, BEP × 3, or BEP × 4, respectively. TCSs had higher median systolic blood pressure (126 vs. 119 mm Hg; P <.001), but fewer were smokers (8.4% vs. 28.2%; P <.001) than controls. In multivariable analysis, no significant differences in FRS between EP × 4, BEP × 3, and BEP × 4 were observed, but less than college education (P <.001) and lack of vigorous exercise (P =.006) were associated with higher FRS. Mean FRS did not differ between TCSs and controls (6.8% vs. 7.3%; P =.67). Conclusion: This is the first study to apply the office-based FRS to TCSs. Chemotherapy regimen (BEP × 3 vs. EP × 4) was not associated with FRS, but less educated and less vigorously active patients had higher FRS, and present a high-risk subgroup for intense follow-up and counseling.
KW - Cytotoxic drugs
KW - Germ cell tumor
KW - Late effects
KW - NHANES controls
KW - Risk model
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U2 - 10.1016/j.clgc.2018.01.011
DO - 10.1016/j.clgc.2018.01.011
M3 - Article
C2 - 29534941
AN - SCOPUS:85043240487
VL - 16
SP - e761-e769
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
SN - 1558-7673
IS - 4
ER -