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Title: Jurnal Medical Aradean (Arad Medical Journal)
Abbreviated title: J. Med. Ar.
Publisher: "Vasile Goldis" University Press
Owner: Western University "Vasile Goldis" Arad, Romania
ISSN: 1224-3744
e-ISSN: 2067-7790

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THE ROLE OF CHEMOTHERAPY IN CANCER PATIENTS WITH A SIGNIFICANT BURDEN OF CARDIOVASCULAR DISEASES PDF Print E-mail

THE ROLE OF CHEMOTHERAPY IN CANCER PATIENTS WITH A SIGNIFICANT BURDEN OF CARDIOVASCULAR DISEASES

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Title: THE ROLE OF CHEMOTHERAPY IN CANCER PATIENTS WITH A SIGNIFICANT BURDEN OF CARDIOVASCULAR DISEASES
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Article_Title: THE ROLE OF CHEMOTHERAPY IN CANCER PATIENTS WITH A SIGNIFICANT BURDEN OF CARDIOVASCULAR DISEASES
Authors: Melinda Csapo Gheorghe1*, Liviu Lazăr2, Silviu Corbu3, Simona Bungău2, Steliana Roxana Miclăuş4
Affiliation: 1*Farmimpex Pharmacy, Oradea, Romania
2Faculty of Medicine and Pharmacy, University of Oradea, Oradea
3Clinical Municipal Hospital, Oradea
4Faculty of Medicine, Transilvania University, Brașov, Romania
Abstract: Chemotherapy treatment requires an adequate cardiovascular status, which most often is impaired. The purpose of this study was to demonstrate the feasability of tailored treatment with curative intent and to define clinical indicators that could have a significant impact within the multimodal approach. Patients from the hematology and medical oncology departments have been prospectively included for a period of one year and a subset was also retrospectively analyzed for a period of two years. Treatment side effects have been encoded using an adapted variant of common terminology criteria for adverse events. Statistical analysis focused primarily on qualitative data followed by quantitative analysis. A number of 81 oncological and 66 hematological patients were included, most of them with stage iv disease (60.5% and 31.8%, respectively). A small number of 13 (8.8%) patients have been without non-cardiovascular patient’s pathological background (PPB). A significant number of 112 (76.2%) patients presented cardiovascular. 107 (72,8%) patients underwent one line of chemotherapy. During chemotherapy, 91 (61.9%) patients developed cardiovascular adverse effects (AE). Patients with hormonal and radiation treatment had a significant higher risk for cardiovascular AE (OR 3.54, p<0.05). Similarly, patients with 3+ cardiovascular PPB had a significantly higher risk of developing AE (OR 3.15, p<0.05). Evaluation of NT-proBNP indicated a shorter study period with 4.6 months (p=0.044). D-dimers over a clinically significant threshold indicated a higher risk for cardiovascular AE (OR 3.11, p=0.03). The median active chemotherapy period was 3.61 months, significantly shorter than the follow up period of 6.84 months (p=0.01). This study demonstrated the feasibility of tailored treatment with curative intent in patients with a significant burden of disease. Published studies have been scarce larger prospective studies are encouraged.
Keywords: cardiovascular, comorbidity, advanced stage, cancer, tailored treatment.
References: Albini A, Pennesi G, Donatelli F, Cammarota R, De Flora S, Noonan DM. Cardiotoxicity of anticancer drugs: the need for cardio-oncology and cardio-oncological prevention. J Natl Cancer Inst. 2010;102(1):14-25.
Brana I, Tabernero J. Cardiotoxicity. Ann Oncol. 2010;21 Suppl 7:vii173-9.
Driver JA, Djousse L, Logroscino G, Gaziano JM, Kurth T. Incidence of cardiovascular disease and cancer in advanced age: prospective cohort study. Br Med J. 2008;337:8.
Dewar GJ, Lim CN, Michalyshyn B, Akabutu J. Gastrointestinal complications in patients with acute and chronic leukemia. Canadian journal of surgery Journal canadien de chirurgie. 1981;24(1):67-71.
Endres L, Bungău S, Tiţ D, Uivaroşan D. Toxic effects of chemotherapy, immunotherapy and chemoimmunotherapy in patients with cutaneous melanoma. Analele Universităţii din Oradea, fascicula: ecotoxicologie, zootehnie şi tehnologii de industrie alimentară. 2014;13(b):163-8.
Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, et al. Annual report to the nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 2014;120(9):1290-314.
Extermann M. Measuring comorbidity in older cancer patients. Eur J Cancer. 2000;36(4):453-71.
Extermann M. Interaction between comorbidity and cancer. Cancer control : journal of the Moffitt Cancer Center. 2007;14(1):13-22.
Ferroni P, Martini F, Portarena I, Massimiani G, Riondino S, La Farina F, et al. Novel High-Sensitive D-dimer Determination Predicts Chemotherapy-Associated Venous Thromboembolism in Intermediate Risk Lung Cancer Patients. Clinical Lung Cancer. 2012;13(6):482-7.
Goede V, Cramer P, Busch R, Bergmann M, Stauch M, Hopfinger G, et al. Interactions between comorbidity and treatment of chronic lymphocytic leukemia: results of German Chronic Lymphocytic Leukemia Study Group trials. Haematologica. 2014;99(6):1095-100.
Herrmann J, Lerman A, Sandhu NP, Villarraga HR, Mulvagh SL, Kohli M. Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clin Proc. 2014;89(9):1287-306.
Kravchenko J, Berry M, Arbeev K, Kim Lyerly H, Yashin A, Akushevich I. Cardiovascular comorbidities and survival of lung cancer patients: Medicare data based analysis. Lung Cancer. 2015;88(1):85-93.
Kravchenko J, Berry MF, Arbeev KG, Akushevich I. Cardiovascular comorbidities in lung cancer patients: Treatment-specific effects on survival. Gerontologist. 2014;54:122.
Lund LH, Donal E, Oger E, Hage C, Persson H, Haugen-Lofman I, et al. Association between cardiovascular vs. non-cardiovascular co-morbidities and outcomes in heart failure with preserved ejection fraction. Eur J Heart Fail. 2014;16(9):992-1001.
Lee L, Cheung WY, Atkinson E, Krzyzanowska MK. Impact of Comorbidity on Chemotherapy Use and Outcomes in Solid Tumors: A Systematic Review. J Clin Oncol. 2011;29(1):106-17.
Pallag A, Rosca E, Mutiu G, Bungau SG, Pop OL. Monitoring the effects of treatment in colon cancer cells using immunohistochemical and histoenzymatic techniques. Rom J Morphol Embryol. 2015;56(3):1103-9.
Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL, jr. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291(20):2441-7.
Piccirillo JF, Feinstein AR. Clinical symptoms and comorbidity: Significance for the prognostic classification of cancer. Cancer. 1996;77(5):834-42.
Stoicescu M, Csepento C, Mutiu G, Bungau S. The role of increased plasmatic renin level in the pathogenesis of arterial hypertension in young adults. Rom J Morphol Embryol. 2011;52(1 suppl):419-23.
Siegel R, Desantis C, Virgo K, Stein K, Mariotto A, Smith T, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62(4):220-41.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7-30.
Uivarosan D, Tit D, Bungău S, Lazăr L, Endres L. The impact of toxics consumption on stroke. Analele Universităţii din Oradea, Fascicula: Ecotoxicologie, zootehnie şi tehnologii de industrie alimentară. 2014;13(b):261-6.
Wedding U, Roehrig B, Klippstein A, Steiner P, Schaeffer T, Pientka L, et al. Comorbidity in patients with cancer: Prevalence and severity measured by cumulative illness rating scale. Critical Reviews in Oncology Hematology. 2007;61(3):269-76.
Wieringa A, Boslooper K, Hoogendoorn M, Joosten P, Beerden T, Storm H, et al. Comorbidity is an independent prognostic factor in patients with advanced-stage diffuse large B-cell lymphoma treated with R-CHOP: a population-based cohort study. Br J Haematol. 2014;165(4):489-96.
Read_full_article: pdf/vol18/iss3/4 JMA 2015 - Melinda Gheorghe - et al ARADzz.pdf
Correspondence: 1*Farmimpex Pharmacy, Oradea, Republicii Street 26, Romania, e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it , Phone number 0748696404
2Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Piata 1 Decembrie Street 10, Romania, e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it , Phone number 0741521060
3Clinical Municipal Hospital, Oradea, Corneliu Coposu Street 12, Romania, e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it , Phone number 0751157577
4Faculty of Medicine, Transilvania University, Brașov, Nicolae Balcescu Street 56, Romania e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it , Phone number 0727797777
Read full article
Article Title: THE ROLE OF CHEMOTHERAPY IN CANCER PATIENTS WITH A SIGNIFICANT BURDEN OF CARDIOVASCULAR DISEASES
Authors: Melinda Csapo Gheorghe1*, Liviu Lazăr2, Silviu Corbu3, Simona Bungău2, Steliana Roxana Miclăuş4
Affiliation: 1*Farmimpex Pharmacy, Oradea, Romania
2Faculty of Medicine and Pharmacy, University of Oradea, Oradea
3Clinical Municipal Hospital, Oradea
4Faculty of Medicine, Transilvania University, Brașov, Romania
Abstract: Chemotherapy treatment requires an adequate cardiovascular status, which most often is impaired. The purpose of this study was to demonstrate the feasability of tailored treatment with curative intent and to define clinical indicators that could have a significant impact within the multimodal approach. Patients from the hematology and medical oncology departments have been prospectively included for a period of one year and a subset was also retrospectively analyzed for a period of two years. Treatment side effects have been encoded using an adapted variant of common terminology criteria for adverse events. Statistical analysis focused primarily on qualitative data followed by quantitative analysis. A number of 81 oncological and 66 hematological patients were included, most of them with stage iv disease (60.5% and 31.8%, respectively). A small number of 13 (8.8%) patients have been without non-cardiovascular patient’s pathological background (PPB). A significant number of 112 (76.2%) patients presented cardiovascular. 107 (72,8%) patients underwent one line of chemotherapy. During chemotherapy, 91 (61.9%) patients developed cardiovascular adverse effects (AE). Patients with hormonal and radiation treatment had a significant higher risk for cardiovascular AE (OR 3.54, p<0.05). Similarly, patients with 3+ cardiovascular PPB had a significantly higher risk of developing AE (OR 3.15, p<0.05). Evaluation of NT-proBNP indicated a shorter study period with 4.6 months (p=0.044). D-dimers over a clinically significant threshold indicated a higher risk for cardiovascular AE (OR 3.11, p=0.03). The median active chemotherapy period was 3.61 months, significantly shorter than the follow up period of 6.84 months (p=0.01). This study demonstrated the feasibility of tailored treatment with curative intent in patients with a significant burden of disease. Published studies have been scarce larger prospective studies are encouraged.
Keywords: cardiovascular, comorbidity, advanced stage, cancer, tailored treatment.
References: Albini A, Pennesi G, Donatelli F, Cammarota R, De Flora S, Noonan DM. Cardiotoxicity of anticancer drugs: the need for cardio-oncology and cardio-oncological prevention. J Natl Cancer Inst. 2010;102(1):14-25.
Brana I, Tabernero J. Cardiotoxicity. Ann Oncol. 2010;21 Suppl 7:vii173-9.
Driver JA, Djousse L, Logroscino G, Gaziano JM, Kurth T. Incidence of cardiovascular disease and cancer in advanced age: prospective cohort study. Br Med J. 2008;337:8.
Dewar GJ, Lim CN, Michalyshyn B, Akabutu J. Gastrointestinal complications in patients with acute and chronic leukemia. Canadian journal of surgery Journal canadien de chirurgie. 1981;24(1):67-71.
Endres L, Bungău S, Tiţ D, Uivaroşan D. Toxic effects of chemotherapy, immunotherapy and chemoimmunotherapy in patients with cutaneous melanoma. Analele Universităţii din Oradea, fascicula: ecotoxicologie, zootehnie şi tehnologii de industrie alimentară. 2014;13(b):163-8.
Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, et al. Annual report to the nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 2014;120(9):1290-314.
Extermann M. Measuring comorbidity in older cancer patients. Eur J Cancer. 2000;36(4):453-71.
Extermann M. Interaction between comorbidity and cancer. Cancer control : journal of the Moffitt Cancer Center. 2007;14(1):13-22.
Ferroni P, Martini F, Portarena I, Massimiani G, Riondino S, La Farina F, et al. Novel High-Sensitive D-dimer Determination Predicts Chemotherapy-Associated Venous Thromboembolism in Intermediate Risk Lung Cancer Patients. Clinical Lung Cancer. 2012;13(6):482-7.
Goede V, Cramer P, Busch R, Bergmann M, Stauch M, Hopfinger G, et al. Interactions between comorbidity and treatment of chronic lymphocytic leukemia: results of German Chronic Lymphocytic Leukemia Study Group trials. Haematologica. 2014;99(6):1095-100.
Herrmann J, Lerman A, Sandhu NP, Villarraga HR, Mulvagh SL, Kohli M. Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clin Proc. 2014;89(9):1287-306.
Kravchenko J, Berry M, Arbeev K, Kim Lyerly H, Yashin A, Akushevich I. Cardiovascular comorbidities and survival of lung cancer patients: Medicare data based analysis. Lung Cancer. 2015;88(1):85-93.
Kravchenko J, Berry MF, Arbeev KG, Akushevich I. Cardiovascular comorbidities in lung cancer patients: Treatment-specific effects on survival. Gerontologist. 2014;54:122.
Lund LH, Donal E, Oger E, Hage C, Persson H, Haugen-Lofman I, et al. Association between cardiovascular vs. non-cardiovascular co-morbidities and outcomes in heart failure with preserved ejection fraction. Eur J Heart Fail. 2014;16(9):992-1001.
Lee L, Cheung WY, Atkinson E, Krzyzanowska MK. Impact of Comorbidity on Chemotherapy Use and Outcomes in Solid Tumors: A Systematic Review. J Clin Oncol. 2011;29(1):106-17.
Pallag A, Rosca E, Mutiu G, Bungau SG, Pop OL. Monitoring the effects of treatment in colon cancer cells using immunohistochemical and histoenzymatic techniques. Rom J Morphol Embryol. 2015;56(3):1103-9.
Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL, jr. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291(20):2441-7.
Piccirillo JF, Feinstein AR. Clinical symptoms and comorbidity: Significance for the prognostic classification of cancer. Cancer. 1996;77(5):834-42.
Stoicescu M, Csepento C, Mutiu G, Bungau S. The role of increased plasmatic renin level in the pathogenesis of arterial hypertension in young adults. Rom J Morphol Embryol. 2011;52(1 suppl):419-23.
Siegel R, Desantis C, Virgo K, Stein K, Mariotto A, Smith T, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62(4):220-41.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7-30.
Uivarosan D, Tit D, Bungău S, Lazăr L, Endres L. The impact of toxics consumption on stroke. Analele Universităţii din Oradea, Fascicula: Ecotoxicologie, zootehnie şi tehnologii de industrie alimentară. 2014;13(b):261-6.
Wedding U, Roehrig B, Klippstein A, Steiner P, Schaeffer T, Pientka L, et al. Comorbidity in patients with cancer: Prevalence and severity measured by cumulative illness rating scale. Critical Reviews in Oncology Hematology. 2007;61(3):269-76.
Wieringa A, Boslooper K, Hoogendoorn M, Joosten P, Beerden T, Storm H, et al. Comorbidity is an independent prognostic factor in patients with advanced-stage diffuse large B-cell lymphoma treated with R-CHOP: a population-based cohort study. Br J Haematol. 2014;165(4):489-96.
*Correspondence: 1*Farmimpex Pharmacy, Oradea, Republicii Street 26, Romania, e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it , Phone number 0748696404
2Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Piata 1 Decembrie Street 10, Romania, e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it , Phone number 0741521060
3Clinical Municipal Hospital, Oradea, Corneliu Coposu Street 12, Romania, e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it , Phone number 0751157577
4Faculty of Medicine, Transilvania University, Brașov, Nicolae Balcescu Street 56, Romania e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it , Phone number 0727797777