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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

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

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.

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Acknowledgements

The authors thank the support of Korea University Anam Hospital Clinical Trial Center.

Funding

This study was funded by a Grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI14C2750).

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Authors and Affiliations

  1. Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea

    Jung Yoon Choi, Yoon Ji Choi, Yeul Hong Kim & Kyong Hwa Park

  2. Department of Biostatistics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Eun Young Cho

  3. Department of Pathology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Jeong Hyeon Lee

  4. Department of General Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Seung Pil Jung

  5. Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Kyu Ran Cho

  6. Department of Radiation Oncology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Chul Yong Kim

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  1. Jung Yoon Choi
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Correspondence to Kyong Hwa Park.

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The authors indicated no potential conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The institutional review board of Korea University Anam Hospital approved and granted this study a waiver of informed consents from participants.

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Choi, J.Y., Cho, E.Y., Choi, Y.J. et al. 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. Breast Cancer Res Treat 171, 181–188 (2018). https://doi.org/10.1007/s10549-018-4809-8

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  • DOI: https://doi.org/10.1007/s10549-018-4809-8

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