Incidence and risk factors for congestive heart failure in patients with early breast cancer who received anthracycline and/or trastuzumab: a big data analysis of the Korean Health Insurance Review and Assessment service database

• Published in: Breast cancer research and treatment 2018-08, Vol.171 (1), p.181-188
• Main Authors: Choi, Jung Yoon, Cho, Eun Young, Choi, Yoon Ji, Lee, Jeong Hyeon, Jung, Seung Pil, Cho, Kyu Ran, Kim, Chul Yong, Kim, Yeul Hong, Park, Kyong Hwa
• Format: Article
• Language: English
• Subjects: Adjuvant chemotherapy; Adult; Aged; Aged, 80 and over; Anthracycline; Anthracyclines; Anthracyclines - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Big Data; Breast cancer; Breast Neoplasms - complications; Breast Neoplasms - drug therapy; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Cancer patients; Cancer research; Cancer therapies; Cardiac patients; Chemotherapy; Comorbidity; Congestive heart failure; Databases, Factual; Development and progression; Epidemiology; Female; Heart failure; Heart Failure - epidemiology; Heart Failure - etiology; Humans; Immunotherapy; Incidence; Medicine; Medicine & Public Health; Middle Aged; Monoclonal antibodies; Oncology; Proportional Hazards Models; Public Health Surveillance; Risk Assessment; Risk Factors; Targeted cancer therapy; Trastuzumab; Trastuzumab - administration & dosage
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-018-4809-8

Purpose We aimed to analyze the incidence, time to occurrence, and congestive heart failure (CHF) risk factors for early breast cancer patients treated with anthracycline (AC)-based chemotherapy and/or trastuzumab (T) therapy in Korea. Methods We included female patients > 19 years old from the Health Insurance Review and Assessment Service database who had no prior CHF history and had been diagnosed with early breast cancer between January 2007 and October 2016. Results We included 83,544 patients in our analysis. In terms of crude incidence for CHF, AC followed by T showed the highest incidence (6.3%). However, 3.1 and 4.2% of the patients had CHF due to AC-based chemotherapy and non-AC followed by T, respectively. The median times to occurrence of CHF were different according to adjuvant treatments, approximately 2 years (701.0 days) in the AC-based chemotherapy group vs 1 year (377.5 days) AC followed by T group. T therapy was associated with earlier development of CHF irrespective of previous chemotherapy, but late risk of CHF 1.2 years after T therapy rapidly decreased in both chemotherapy groups. Multivariate Cox regression analysis revealed that the adjusted hazard ratio for CHF was increased in the group of older patients (≥ 65 years old) who underwent AC followed by T therapy, with Charlson comorbidity index scores of ≥ 2. Conclusions Our study showed that neo-/adjuvant chemotherapy using T irrespective of previous chemotherapy (AC or non-AC) was associated with significantly increased risk of CHF compared with AC-based chemotherapy in Korean patients with early breast cancer.