A retrospective analysis conducted by researchers at Kaiser Permanente and UCLA has concluded that patients with breast cancer treated with aromatase inhibitors (AIs) as adjuvant endocrine therapy were at equal risk of serious cardiovascular disease (CVD) events as those treated with tamoxifen.  

Researchers conducted a retrospective analysis of more than 13,000 postmenopausal women with hormone receptor—positive breast cancer but no CVD complications diagnosed between January 1, 1991, and December 31, 2010; these women were followed through December 31, 2011.

Participants were assigned to 1 of 3 cohorts: adjuvant endocrine therapy with either tamoxifen, an AI, or neither. During the follow-up period, a total of 3711 CVD events were recorded. Of these, AI-only users had a similar risk of cardiac ischemia (myocardial infarction and angina) (adjusted hazard ratio [HR], 0.97; 95% CI, 0.78-1.22) and stroke (adjusted HR, 0.97; 95% CI, 0.70-1.33) when compared with those treated with tamoxifen alone.

However, using AI therapy alone (adjusted HR, 1.29; 95% CI, 1.11-1.50) or subsequent to tamoxifen (adjusted HR, 1.26; 95% CI, 1.09-1.45), increased women’s risk of other CVDs (dysrhythmia, valvular dysfunction, and pericarditis).  

“Our study is a comprehensive assessment of the impact aromatase inhibitors have on cardiovascular risk and provides reassurance that the hormone therapy to reduce breast cancer recurrence does not increase risk of the most fatal cardiovascular events,” said Reina Haque, PhD, MPH, research scientist, Kaiser Permanente Southern California Department of Research & Evaluation, in a statement. Haque is the lead author on the study, which has been published in 

“A particular strength of our study is that we accounted for women’s other potential cardiovascular risk factors as well as medication used to treat high blood pressure and high cholesterol.”  

Based on their findings, the authors believe that further studies to assess the risk of other CVD events are warranted.  

Haque R, Shi J, Schottinger JE, et al. Cardiovascular disease after aromatase inhibitor use [published online April 21, 2016]. 

Surabhi Dangi-Garimella, PhD, is a writer and editor for the 

Articles

Comparing CVD Risk Factors Associated With Adjuvant Endocrine Therapies

A claims-based retrospective study in a Medicare population has found that family members of patients who died of cancer were more likely to report the patient’s end-of-life (EOL) care as “excellent” if hospice care was longer than 3 days, if patients were not admitted to the intensive care unit (ICU) within the last 30 days of death, or if the patient died outside of a hospital setting.

The results of this study underscore the importance of advance care planning in improving the quality of care that patients receive at EOL, ensuring that the treatment or care the patient receives meets their goals of care.

The study included analysis of interviews with 1146 bereaved family members of Medicare patients with advanced lung or colorectal cancer who had died by 2011. The study examined claims-based quality measures of aggressive EOL care, which included ICU admission or repeat hospitalizations or emergency department visits during the last 30 days of life, chemotherapy administered in the last 2 weeks of life, no hospice of less than 3 days of hospice, and death in the hospital.

A slight majority of family members (51.3%) reported EOL care as excellent. Additionally, about 59% of family members were happy if hospice care extended beyond 3 days, but 45% were unhappy if the patient was in the ICU 30 days prior to death. More than 42% of family members of patients who died in the hospital setting reported being unhappy with EOL care.

The authors concluded that earlier hospice enrollment, avoidance of ICU admissions within 30 days of death, and death occurring outside the hospital were associated with perceptions of better EOL care, and that their findings are supportive of advance care planning consistent with the preferences of patients.

“Our study findings are a powerful argument for the importance of advance care planning,” lead study author Alexi A. Wright, MD, MPH, of Harvard Medical School and Dana-Farber Cancer Institute said in a statement.

“The more information patients have, the more likely they are to receive the kind of medical care they want near death. And patients’ deaths influence family members’ perceptions of their quality of care.”

Wright reported that end-of-life care could be of higher quality if there are efforts to enroll patients in hospice earlier—not when death is imminent&mdash;and to avoid intensive care unit admissions in the final weeks.

Wright AA, Keating NL, Ayanian JZ, et al. Family perspectives on aggressive cancer care near the end of life. 

Surabhi Dangi-Garimella, PhD, is a writer and editor for the American Journal of Managed Care, Evidence-Based Oncology. Read more at 

The results of this study underscore the importance of advance care planning in improving the quality of care that patients receive at end-of-life.

Surabhi Dangi-Garimella, AJMC.com

Articles

Comparing CVD Risk Factors Associated With Adjuvant Endocrine Therapies

Families Have Distinct Preferences for End-of-Life Care