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Abstract
Background:
A retrospective cohort study
utilizing prospectively collected data was conducted from August 2003
until March
2008 at M. D. Anderson Cancer Center. It is unknown
whether cardiovascular comorbidity and chronic stress impact ovarian
cancer
outcome, which remains poor despite advances in
therapy. The purpose of this study was to determine whether
cardiovascular
disease and markers that may be associated with
stress are also associated with survival in ovarian cancer patients.
Methods:
Participants with newly diagnosed
epithelial ovarian cancer were followed until time of death or
truncation of study
period (median follow-up = 4.2 years; n=271). Tumor
characteristics (stage, tumor grade, histology, debulking status),
demographic
variables,and cardiovascular comorbidity were
documented and compared to overall survival.
Results:
Of the 9 cardiovascular events tracked
during follow-up, venous thromboembolism (VTE; Hazard Ratio= 3.2; 95%CI =
1.8-5.5)
and pulmonary hypertension (Hazard Ratio=8.5;
95%CI= 3.9- 18.7) were associated with shorter survival in multivariate
analysis.
In addition, high tumor grade, suboptimal
cytoreduction, and baseline heart rate (Hazard Ratio=1.02; 95%CI= 1.01-
1.04) were
related to decreased survival.
Conclusions:
Careful management of certain
cardiovascular comorbidities may extend survival in patients with
ovarian cancer.
Our findings suggest that increased baseline heart
rate and the development of VTE and pulmonary hypertension after cancer
diagnosis may be significant predictors of survival
in women with ovarian cancer.
Impact: Our study emphasizes the importance of
identifying and optimally treating tachycardia, VTE and pulmonary
hypertension
in conjunction with cancer therapy.
DVT (deep vein thrombosis) and pleural effusion is not uncommon in patients with ovarian cancer. It may be a presenting sign. Workup which was triggered by this presentation revealed ovarian carcinoma in my spouse. However, she was treated with total abdominal hysterectomy and Chlorambucil (Leukeran). This postoperative chemotherapy drug is among the slowest acting and least toxic of the alkylating agents (well tolerated oral drugs). By giving chemotherapy more often, at lower doses, it can prevent the regrowth of blood vessels that feed tumors (angiogenesis).
ReplyDeleteIn addition, she received talc pleurodesis, which is a common treatment modality for patients with malignant pleural effusion, secondary to ovarian cancer. Talc causes tumor growth to slow down and actually decreases the tumor bulk, by stimulating healthy cells to produce the hormone endostatin. Talc is able to prevent the formation of blood vessels, thereby killing the tumor and choking off its growth. Pleural effusions indicate that the cancer has spread throughout the body. She went 24 years before having a recurrence.