Cardiac events in stage III NSCLC treated in daily clinical practice

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Published: 25 Oct 2018
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Dr Juliette Degens - Academisch Ziekenhuis Maastricht, Maastricht, Netherlands

Dr Juliette Degens speaks with ecancer at ESMO 2018 in Munich about her study investigating the incidents of pre-existed cardiac comorbidity and cardiac incidents after diagnosis of lung cancer in patients that would be treated in daily clinical practice.

Dr Degens explains that 30% of patients had pre existing cardiac comorbidity and that 33% of patients developed a new cardiac event within 5 years of diagnosis.

ecancer's filming has been kindly supported by MSD through the ecancer Global Foundation. ecancer is editorially independent and there is no influence over content.

My presentation is in the field of cardiac toxicity in lung cancer patients. Previous studies in 2017 have shown a high incidence of cardiac events in non-small cell lung cancer patients. However, the patients which were seen in these investigations were patients all treated in dose escalated radiotherapy trials so therefore they do not fully reflect on the patients that we treat in our daily clinical practice. So the aim of our study was to investigate the incidence of pre-existing cardiac morbidity and cardiac incidence after diagnosis of lung cancer in patients that we treat in our daily clinical practice.

How was this conducted?

This was a multicentre retrospective cohort study and we did a patient file research of all the patients that were included in our study.

What were some of the key findings?

We included 460 patients in our study and 30% of our patients had pre-existing cardiac comorbidity. We saw that 33% of our patients developed a new cardiac event within five years after their diagnosis where the main part of the events were in the first two years after diagnosis. Actually we categorised the cardiac events into five categories – heart failure, coronary artery disease, arrhythmias, pericardial disease and cardiomyopathy. The most seen cardiac events, about 15% of our patients showed arrhythmia, 7% of our patients showed both heart disease, not at the same time but 7% heart failure and 7% symptomatic coronary artery disease, and smaller groups, 3%, showed pericardial effusion and another 1.5% showed cardiomyopathy.

What does this mean for refining screening behaviours ahead of treatment?

That’s a good question, of course. We still have a lot of work to do in this field of expertise and we cannot speak about a screening programme yet. But I do think it’s very important that we are aware of these numbers and that the collaboration between a pulmonologist and a cardiologist is crucial in giving optimal treatment to these patients.

Then is there room for any patient advocacy involvement for communicating the risks that patients might have as these treatments go on?

We tried to identify risk factors in these patients and in a multivariate analysis we saw that male gender, a performance score of 2 and above and pre-existing cardiac comorbidity were significant risk factors for getting a new cardiac event. So in daily clinical practice we have to keep in mind these risk factors but I also think that we still have to do more research to investigate other clinical risk factors in these patients.