Older women with breast cancer who receive adjuvant anthracycline chemotherapy have significantly increased rates of congestive heart failure (CHF), according to results of a new study. Older women with breast cancer who receive adjuvant anthracycline chemotherapy have significantly increased rates of congestive heart failure (CHF), according to results of a study published in the September issue of the Journal of Clinical Oncology.

"Anthracyclines are among the most effective drugs for the treatment of patients with breast cancer," Dr. Sharon H. Giordano and colleagues from the University of Texas M.D. Anderson Cancer Center, Houston, write. "Limited data are available on long-term cardiac safety of adjuvant anthracycline chemotherapy in breast cancer patients over age 65 years."

The researchers examined data in the Surveillance, Epidemiology, and End Results Medicare database regarding women between the ages of 66 and 80 years with no history of CHF and who were diagnosed with stage I to III breast cancer from 1992 to 2002. The team estimated cumulative rates of CHF and examined factors associated with the development of CHF.

A total of 43,338 women, median age 73.2 years, were included in the study. Of these, 34,705 (80 per cent) received no adjuvant chemotherapy, 4712 (11 per cent) received adjuvant anthracyclines, and 3921 (nine per cent) received non-anthracycline adjuvant chemotherapy. The patients were followed for a median of 56 months. Overall, 10,096 patients (23.3 per cent) had subsequently developed CHF.

Anthracycline-treated women between the ages of 66 and 70 years had a 26 per cent higher risk of developing CHF compared with those treated with non-anthracycline regimens. However, adjuvant chemotherapy type was not associated with CHF in subjects aged 71 to 80.

"At five years of follow-up, we observed absolute differences of one and 4.6 per cent respectively in rates of CHF between anthracycline-treated women in this age group (66 to 70 years) and those who received other adjuvant chemotherapy or no chemotherapy," Dr. Giordano's team reports. "After ten years, the increased risk of CHF in anthracycline-treated patients was amplified rather than attenuated."

The investigators say their findings underscore the need for prospective studies to "quantify the risk of CHF and to define chemotherapy regimens with the best therapeutic ratio for this group.

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