Association Between Radiotherapy and Death From Cardiovascular Disease Among Patients With Cancer: A Large Population-Based Cohort Study

Abstract

BACKGROUND: This study aimed to investigate the association between radiotherapy for cancer and cardiovascular disease (CVD) deaths and evaluate the relative risk for CVD deaths in the general population and among patients with cancer treated with radiotherapy. METHODS AND RESULTS: The statistics of cancers from 16 sites were extracted from the Surveillance, Epidemiology, and End Results database and evaluated. Multivariable Cox proportional hazards regression analysis was used to analyze the association between radiotherapy and cardiovascular-specific survival. The standardized mortality ratio for CVD deaths was estimated by comparing the observed deaths of patients with cancer treated with radiotherapy to the expected deaths of the general population. Of the 2 214 944 patients identified from the database, 292 102 (13.19%) died from CVD. Multivariable Cox proportional hazards regression analyses demonstrated that radiotherapy was an independent risk factor for cardiovascular-specific survival among patients with lung and bronchus, cervix uteri, corpus uteri, and urinary bladder cancers. The long-term cardiovascular-specific survival of patients with cancer who underwent radiotherapy was significantly lower than that of patients who did not undergo radiotherapy. The incidence of CVD deaths among patients with lung and bronchus, cervix uteri, corpus uteri, and urinary bladder cancers who underwent radiotherapy was higher than that among the general population. Standardized mortality ratio significantly decreased with increasing age at cancer diagnosis, gradually decreased within 10 years of diagnosis and increased after 10 years of diagnosis. CONCLUSIONS: Radiotherapy is associated with worse cardiovascular-specific survival in patients with lung and bronchus, cervix uteri, corpus uteri, and urinary bladder cancers. Long-term surveillance of cardiovascular conditions should be performed after radiotherapy.