接触潜在心脏毒性癌症药物的澳大利亚人的患病率：一项基于人群的队列研究。
Prevalence of Australians exposed to potentially cardiotoxic cancer medicines: a population-based cohort study.
作者信息
Daniels Benjamin, Aslam Maria, van Leeuwen Marina T, Brown Martin, Hunt Lee, Gurney Howard, Tang Monica, Pearson Sallie-Anne, Vajdic Claire M
机构信息
Medicines Intelligence Research Program, School of Population Health, UNSW Sydney, Australia.
Cancer Services, Hunter New England Local Health District, Newcastle, Australia.
出版信息
Lancet Reg Health West Pac. 2023 Aug 2;39:100872. doi: 10.1016/j.lanwpc.2023.100872. eCollection 2023 Oct.
BACKGROUND
Cardiovascular disease (CVD) and cancer are leading causes of death and people with cancer are at higher risk of developing CVD than the general population. Many cancer medicines have cardiotoxic effects but the size of the population exposed to these potentially cardiotoxic medicines is not known. We aimed to determine the prevalence of exposure to potentially cardiotoxic cancer medicines in Australia.
METHODS
We identified potentially cardiotoxic systemic cancer medicines through searching the literature and registered product information documents. We conducted a retrospective cohort study of Australians dispensed potentially cardiotoxic cancer medicines between 2005 and 2021, calculating age-standardised annual prevalence rates of people alive with exposure to a potentially cardiotoxic medicine during or prior to each year of the study period.
FINDINGS
We identified 108,175 people dispensed at least one potentially cardiotoxic cancer medicine; median age, 64 (IQR: 52-74); 57% female. Overall prevalence increased from 49 (95%CI: 48.7-49.3)/10,000 to 232 (95%CI: 231.4-232.6)/10,000 over the study period; 61 (95%CI: 60.5-61.5)/10,000 to 293 (95%CI: 292.1-293.9)/10,000 for females; and 39 (95%CI: 38.6-39.4)/10,000 to 169 (95%CI: 168.3-169.7)/10,000 for males. People alive five years following first exposure increased from 29 (95%CI: 28.8-29.2)/10,000 to 134 (95%CI: 133.6-134.4)/10,000; and from 22 (95%CI: 21.8-22.2)/10,000 to 76 (95%CI: 75.7-76.3)/10,000 for those alive at least 10 years following first exposure. Most people were exposed to only one potentially cardiotoxic medicine, rates of which increased from 39 (95%CI: 38.7-39.3)/10,000 in 2005 to 131 (95%CI: 130.6-131.4)/10,000 in 2021.
INTERPRETATION
The number of people exposed to efficacious yet potentially cardiotoxic cancer medicines in Australia is growing. Our findings can support the development of service planning and create awareness about the magnitude of cancer treatment-related cardiotoxicities.
FUNDING
NHMRC Centre for Research Excellence in Medicines Intelligence, Cancer Institute NSW Early Career Fellowship.
背景
心血管疾病（CVD）和癌症是主要的死亡原因，癌症患者患心血管疾病的风险高于普通人群。许多癌症药物具有心脏毒性作用，但接触这些潜在心脏毒性药物的人群规模尚不清楚。我们旨在确定澳大利亚接触潜在心脏毒性癌症药物的患病率。
方法
我们通过检索文献和已注册的产品信息文件，确定了潜在心脏毒性的全身性癌症药物。我们对2005年至2021年间在澳大利亚配给潜在心脏毒性癌症药物的人群进行了一项回顾性队列研究，计算了在研究期间每年或之前接触潜在心脏毒性药物的存活人群的年龄标准化年患病率。
结果
我们确定有108,175人配给了至少一种潜在心脏毒性癌症药物；中位年龄为64岁（四分位间距：52 - 74岁）；女性占57%。在研究期间，总体患病率从49（95%置信区间：48.7 - 49.3）/10,000增加到232（95%置信区间：231.4 - 232.6）/10,000；女性从61（95%置信区间：60.5 - 61.5）/10,000增加到293（95%置信区间：292.1 - 293.9）/10,000；男性从39（95%置信区间：38.6 - 39.4）/10,000增加到169（95%置信区间：168.3 - 169.7）/10,000。首次接触后存活5年的人群从29（95%置信区间：28.8 - 29.2）/10,000增加到134（95%置信区间：133.6 - 134.4）/10,000；首次接触后存活至少10年的人群从22（95%置信区间：21.8 - 22.2）/10,000增加到76（95%置信区间：75.7 - 76.3）/10,000。大多数人仅接触一种潜在心脏毒性药物，其发生率从2005年的39（95%置信区间：38.7 - 39.3）/10,000增加到2021年的131（95%置信区间：130.6 - 131.4）/10,000。
解读
在澳大利亚，接触有效但潜在心脏毒性癌症药物的人数正在增加。我们的研究结果可为服务规划的制定提供支持，并提高对癌症治疗相关心脏毒性规模的认识。
资助
澳大利亚国家卫生与医学研究委员会药物情报卓越研究中心、新南威尔士州癌症研究所早期职业奖学金。
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