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Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy: Application of the Framingham Risk Score
- Source :
- Clinical genitourinary cancer. 16(4)
- Publication Year :
- 2017
-
Abstract
- 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.
- Subjects :
- Adult
Male
medicine.medical_specialty
animal structures
National Health and Nutrition Examination Survey
Adolescent
Urology
medicine.medical_treatment
030204 cardiovascular system & hematology
Article
03 medical and health sciences
Bleomycin
Young Adult
0302 clinical medicine
Cancer Survivors
Testicular Neoplasms
Risk Factors
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Young adult
Testicular cancer
Etoposide
Chemotherapy
Framingham Risk Score
business.industry
Middle Aged
medicine.disease
Chemotherapy regimen
Blood pressure
Oncology
Cardiovascular Diseases
030220 oncology & carcinogenesis
Cisplatin
business
medicine.drug
Subjects
Details
- ISSN :
- 19380682
- Volume :
- 16
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Clinical genitourinary cancer
- Accession number :
- edsair.doi.dedup.....8d53dde1a90fdc79581c924b7977371b