Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy: Application of the Framingham Risk Score

Darren R. Feldman, Shirin Ardeshir-Rouhani-Fard, Patrick Monahan, Howard D. Sesso, Chunkit Fung, Annalynn M. Williams, Robert J. Hamilton, David J. Vaughn, Clair J. Beard, Ryan Cook, Mohammad Abu Zaid, Steven E Lipshultz, Lawrence H. Einhorn, Kevin C. Oeffinger, Lois B. Travis, Sophie D. Fossa

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
JournalClinical Genitourinary Cancer
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

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Testicular Neoplasms
Cisplatin
Survivors
Cardiovascular Diseases
Drug Therapy
Blood Pressure
Education
Nutrition Surveys
Bleomycin
Etoposide
Life Style
Counseling
Linear Models

Keywords

  • Cytotoxic drugs
  • Germ cell tumor
  • Late effects
  • NHANES controls
  • Risk model

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy : Application of the Framingham Risk Score. / Feldman, Darren R.; Ardeshir-Rouhani-Fard, Shirin; Monahan, Patrick; Sesso, Howard D.; Fung, Chunkit; Williams, Annalynn M.; Hamilton, Robert J.; Vaughn, David J.; Beard, Clair J.; Cook, Ryan; Zaid, Mohammad Abu; Lipshultz, Steven E; Einhorn, Lawrence H.; Oeffinger, Kevin C.; Travis, Lois B.; Fossa, Sophie D.

In: Clinical Genitourinary Cancer, 01.01.2018.

Research output: Contribution to journalArticle

Feldman, DR, Ardeshir-Rouhani-Fard, S, Monahan, P, Sesso, HD, Fung, C, Williams, AM, Hamilton, RJ, Vaughn, DJ, Beard, CJ, Cook, R, Zaid, MA, Lipshultz, SE, Einhorn, LH, Oeffinger, KC, Travis, LB & Fossa, SD 2018, 'Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy: Application of the Framingham Risk Score', Clinical Genitourinary Cancer. https://doi.org/10.1016/j.clgc.2018.01.011
Feldman, Darren R. ; Ardeshir-Rouhani-Fard, Shirin ; Monahan, Patrick ; Sesso, Howard D. ; Fung, Chunkit ; Williams, Annalynn M. ; Hamilton, Robert J. ; Vaughn, David J. ; Beard, Clair J. ; Cook, Ryan ; Zaid, Mohammad Abu ; Lipshultz, Steven E ; Einhorn, Lawrence H. ; Oeffinger, Kevin C. ; Travis, Lois B. ; Fossa, Sophie D. / Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy : Application of the Framingham Risk Score. In: Clinical Genitourinary Cancer. 2018.
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title = "Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy: Application of the Framingham Risk Score",
abstract = "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.",
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author = "Feldman, {Darren R.} and Shirin Ardeshir-Rouhani-Fard and Patrick Monahan and Sesso, {Howard D.} and Chunkit Fung and Williams, {Annalynn M.} and Hamilton, {Robert J.} and Vaughn, {David J.} and Beard, {Clair J.} and Ryan Cook and Zaid, {Mohammad Abu} and Lipshultz, {Steven E} and Einhorn, {Lawrence H.} and Oeffinger, {Kevin C.} and Travis, {Lois B.} and Fossa, {Sophie D.}",
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T1 - Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy

T2 - Application of the Framingham Risk Score

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.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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 - 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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