Background:
Little is known about the outcomes of cardiovascular interventions and therapeutics in cancer patients. Understanding these outcomes can improve cancer patients’ risk stratification, survival, and quality of life. Here, we sought to assess the reporting of outcome data of cancer patients in major cardiovascular medicine trials.
Methods:
We conducted a literature search of clinical trials, published in the four highest-impact, general cardiology journals (Journal of the American College of Cardiology [JACC], European Heart Journal [EHJ], Circulation, and JAMA Cardiology) between 2014 and 2019. We used the keywords “random*” OR “Controlled” OR “trial” OR “RCT”. After screening to exclude irrelevant results, we inspected the full methods, results, and supplementary materials of retrieved trials.
Results:
Data analysis showed that among the retrieved 754 trials, 38 studies initially excluded cancer patients in their eligibility criteria, while 629 results did not report any results on cancer. Further, 44 studies reported on cancer as a safety outcome in previously non-cancer patients. Only 43 (5.7%) trials reported subgroup analysis results for cancer patients in terms of the primary outcome. Among the latter, 23 trials (53.5%) included patients with CAD, while 6 (14%) and 9 (21%) enrolled patients with heart failure and atrial fibrillation, respectively. The median number of included cancer patients in those studies was 58 (interquartile range: 4 to 167) in comparison to a median sample size of 1,258 (IQR: 220 to 8,480).
Conclusion:
Cancer patients often do not receive adequate attention in cardiovascular medicine trials. Whenever possible, investigators are encouraged to pre-specify subgroup analyses for cancer patients. This can be achieved by promoting research training in cardio-oncology, collaborations between cardiologists and oncologists and increasing the recruitment of cancer patients to cardiovascular medicine trials. |
