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 Einhorn, Kevin C. Oeffinger, Lois B. Travis, Sophie D. Fossa

Research output: Contribution to journalArticle

1 Citation (Scopus)

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

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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; 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, L, 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 ; 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 Lawrence Einhorn 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

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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