306P - Patient-reported symptoms in early breast cancer and future cardiovascular events: A province-wide administrative database study

Background

In developed countries, with advances in chemotherapy treatments cardiovascular diseases (CVD) are a competing cause of morbidity and mortality in early breast cancer (EBC). Within 3 years of chemotherapy completion, heart failure rates in EBC are 3X that of age-matched controls. Psychologic distress is known to negatively affect CVD incidence and prognosis in women. In oncology, distress is termed the ‘6th vital sign’, commonly assessed and reported. Since 2016, electronic entry of Edmonton Symptom Assessment System (ESAS) was phased in Alberta cancer clinics. Accordingly, we searched province-wide administrative databases to examine the potential impact of patient-reported outcome measures (PROMs) on future CVD events in EBC.

Methods

After excluding non-breast cancers, metastatic disease, or research protocol, 3101 EBC cases received chemotherapy from January 1 2016 to December 31 2020. Our primary outcome was a composite of inpatient or outpatient ICD-10 coded CVD events within 3 years of chemotherapy completion. 371 cases had CVD events and ESAS recorded. ESAS PROMs (pain, tiredness, drowsiness, nausea, appetite, dyspnea, depression, anxiety, wellbeing) recorded within 6 months of chemotherapy initiation were assessed.

Results

The data were very similar for inpatient and outpatient groups with total Principal Component Analysis (PCA) 1 35.7 & 38.4, & PCA2 29.8 & 30.4 respectively. The non-parametric comparison for inpatient cases when comparing CVD vs none shows depression is the strongest contributor among the analyzed variables with p-value 0.0089. Outpatient variables, age and HER2 status did not pass the p-value threshold. Table: 306P

Conclusions

Depression reported early in EBC trajectory is associated with future CVD events requiring hospitalization. This novel finding has implications in assessment and provision of early supportive care. Future work should assess larger datasets and non-CVD events relevant to EBC survivors.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Edith Pituskin.

Funding

Alberta Innovates Precision Health.

Disclosure

All authors have declared no conflicts of interest.