Purpose: Recent studies have suggested that the deaths of patients with peripheral arterial disease (PAD), which historically had been attributed to cardiovascular events, has begun to shift toward more patients with PAD dying of cancer. Moreover, a few studies have suggested that cancer patients with PAD have a worse outcome with cancer than patients without PAD. We performed a retrospective review of breast cancer patients with PAD at Memorial Sloan Kettering Cancer Center to assess the demographics, risk factors profile, risk factor modifications, and outcome in this patient population.
Materials and Methods: A Dataline inquiry was made for patients carrying ICD-9: 443.9 and ICD-10: 173.9 codes for PAD and peripheral vascular disease, respectively, from June 1, 2009, to June 1, 2019. Patients with only a cancer diagnosis of breast cancer were included in the study. We reviewed electronic medical records to obtain information, including demographics, risk factors, use of risk factor modifications, and outcome.
Results: A total of 248 patients met criteria to be included in the study. As expected, 98% were women. A large proportion of our breast cancer patients who were with PAD had risk factors of smoking (44%), obesity (38%), hyperlipidemia (68%), hypertension (74%) and diabetes (42%). Hypertension, the most prevalent risk factor, was found to negatively impact the survival of this population (P = 0.005). Risk factor modifications included 42% of patients being prescribed on a statin and 50% prescribed aspirin. In addition, 62% of smokers were offered a smoking cessation plan. This is of importance because our study demonstrated a trend toward improved survival in nonsmokers compared with smokers in this population. Reflecting the more recent data that suggest these patients are dying more of their cancers rather than cardiovascular disease, we demonstrated a greater proportion of patients dying of their breast cancer rather than cardiovascular events even when cancer stage was considered.
Conclusions: Our study population had risk factors consistent with the known understanding of PAD, but with improved attention to risk factor modification, these patients may be dying of their cancer rather than cardiovascular events. As a continuation of this project, we hope to expand this analysis on other cancer types and perform a case-control study to assess the true impact of PAD on cancer patients.