Risk factors for cardiovascular complications in patients with left breast cancer in daily clinical practice

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Abstract

Purpose. Detection of adherence to a healthy lifestyle (HLS) and evaluation of behavioral risk factors for cardiovascular complications (CVC), including psychosocial, in patients with left breast cancer at the stage of chemoradiotherapy in daily clinical practice.

Materials and methods. The patients were hospitalized for 3D conformal radiation therapy on the bed of the left breast with a total radiation dose (TRD) of 39 Gy (equivalent to 48 Gy of conventional fractionation). All the patients had a Madden mastectomy at the previous stages followed by doxorubicin therapy at a cumulative dose not exceeding 360 mg/m2. Determination of all components of a healthy lifestyle was carried out according to the data of interviewing the participants. The risk category of cardiovascular complications was assessed according to the SCORE scale. Additional characteristics including psychosocial factors were assessed. The examination included ECG and echocardiography.

Results. At the initial examination, 58% of middle-aged patients and 74% of elderly patients showed comorbidity, while 18% of middle-aged patients and 29% of elderly patients had multiple comorbidities. Low adherence to healthy lifestyle in the patients was primarily associated with low physical activity due to the existing pain syndrome caused by both the tumor process itself and the surgical intervention. Physical activity in both groups was significantly lower than in the general population. High risk of CVC was significantly more common in the elderly patients. Systolic and diastolic dysfunction as a manifestation of cardiotoxicity after the previous stage of doxorubicin therapy were detected in middle-aged patients in 35.7% of the cases, in the elderly patients in 56.5% of the cases (HR 0.643, 95% CI 0.470-0.880). Psychosocial factors such as acute chronic stress and family problems were the most common. All the examined patients showed moderate reactive anxiety. The elderly patients showed a high level of personal anxiety.

Conclusions. The obtained data suggest that in breast cancer patients, low adherence to HLS is primarily associated with low physical activity and ‘unhealthy diet’ and to a much lesser extent smoking, which is of great importance in the formation of a healthy lifestyle in these patients in the future. In elderly patients, the study significantly more often identified risk factors such as obesity, high blood pressure, hypercholesterolemia and hyperglycemia. These patients revealed increased level of personal anxiety. This highlights the need for an expanded study of not only the main but also additional risk factors.

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About the authors

Elena G. Poroshina

North-West State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: elporoshina@mail.ru

docent

Russian Federation, KSaint Petersburg

Irina V. Vologdina

A.M. Granov Russian Research Center for Radiology and Surgical Technologies

Email: Vologdina@yandex.ru

doctor of Medicine Sciences

Russian Federation, Saint Petersburg

Razifa M. Zhabina

A.M. Granov Russian Research Center for Radiology and Surgical Technologies

Email: RAZIFA@list.ru

Doctor of Medical Sciences, Honored Doctor of the Russian Federation, Head of the Radiotherapy Department No. 1

Russian Federation, Saint Petersburg

Andrey A. Stanzhevsky

A.M. Granov Russian Research Center for Radiology and Surgical Technologies

Email: stanzhevsky@gmail.com

Doctor of Medcine Sciences.Deputy Director for Research

Russian Federation, Saint Petersburg

Larisa A. Krasilnikova

A.M. Granov Russian Research Center for Radiology and Surgical Technologies

Email: krasilka@gmail.com

MD, doctor of functional diagnostics

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. The distribution of the patients with different concomitant diseases (%)

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3. Fig. 2. Risk factors assessment according to the SCORE scale (%)

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4. Fig. 3. The level of reactive and personal anxiety according to the Spielberger-Hanin scale

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Copyright (c) 2020 Poroshina E.G., Vologdina I.V., Zhabina R.M., Stanzhevsky A.A., Krasilnikova L.A.

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