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Congestive Heart Failure in Older Women: Anthracyclines

Congestive heart failure (CHF) in older women treated with anthracycline (A) chemotherapy (C) [American Society of Clinical Oncology]

Background: There are little available data on the long-term cardiac safety of anthracycline chemotherapy in women over age 65, so we evaluated rates and predictors of CHF in this population of older women.

Methods: We used data from the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database and included women aged 66-90 years who were diagnosed with breast cancer from 1992-1999, had no other cancers, and no history of CHF.

Multivariable Cox regression analysis was used to estimate the 5- and 10-year cumulative rates of CHF and to determine the factors independently associated with the development of CHF.

Results: A total of 34,621 women were included in this observational study: 28,640 who received no C, 3253 who received non-A C, and 2728 who received A C.

Women who received A tended to be younger, have lower comorbidity scores, and have more advanced disease than women treated with non-A chemo or women who did not receive chemotherapy (p<0.001 for each). By multivariable Cox regression analysis, the 5- and 10-year rates of CHF in women aged 66-70 years were 19% and 47% for the A C cohort, 14% and 33% for the non-A C cohort, and 12% and 28% for the no C cohort.

The adjusted hazard ratio was 1.45 (95% CI 1.19-1.76) for A C versus other C and was 0.97 (95% CI 0.82-1.14) for no C versus other C. The rates of CHF were not statistically different among women in the older age cohorts, although selection biases were likely stronger.

Other significant predictors of CHF included black race (HR 1.28, 1.17-1.40), increasing comorbidity, and preceding diagnosis of hypertension (HR 1.40, 1.34-1.47), diabetes (HR 1.23, 1.16-1.30), and peripheral vascular disease (HR 1.26, 1.19-1.34).

Conclusions: Although women ages 66-70 treated with A tended to be healthier than women treated with other types of chemotherapy, the rates of CHF among women treated with A were significantly higher. The difference in rates of CHF continued to increase through 10 years of follow-up.

Abstract #521

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