Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Pre-existing and post-cancer major cardiovascular disease and their association with mortality outcomes among cancer survivors in New South Wales (146074)

MD Mijanur Dr Rahman 1 2 3 , Katy Prof Bell 4 , Grace Prof Joshy 5 , Michael Prof David 2 , Karen Prof Canfell 4 , David Goldsbury 2 , Bogda Prof Koczwara 6 , Emily Prof Banks 6 , Kazuaki Prof Negishi 3 , Geoff Prof Delany 1 , Mei Ling Assoc Prof Yap 1 , Xue Qin Yu 2
  1. CCORE, Ingham Institute, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
  2. The Daffodil Centre, a joint venture between University of Sydney and Cancer Council NSW, University of Sydney, Sydney, NSW, Australia
  3. School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
  4. Sydney School of Public Health, , University of Sydney, Sydney, Australia, Sydney, NSW, Australia
  5. 9. National Centre for Epidemiology and Population Health, , Australian National University, Canberra, Australia, Canberra, ACT, Australia
  6. Australian Research Centre for Cancer Survivorship, University of New South Wales, Sydney, NSW, Australia

Background: As cancer survival improves, cardiovascular disease (CVD) has emerged as a major competing cause of death. However, population-level evidence on the burden of pre-existing and post-cancer CVD remains limited. This study aims to quantify pre-existing and post-cancer major CVD and their association with mortality outcomes, among people with cancer.

 

Methods: This study utilised population-wide data from the Cancer Institute NSW CanDLe linkage. Major CVD was identified using linked hospital records among 344,336 adults registered with primary invasive cancer in the New South Wales Cancer Registry from 2006-2016. The cohort was followed up until 31 December 2021. Fine-Grey modelling estimated sub-distributional hazard ratios (sHR) for cancer and cardiovascular mortality, and Cox proportional hazard modelling estimated hazard ratio for mortality from any cause across 20 common cancers.

 

Findings: Overall, 18%(n=62,675) of participants had pre-existing CVD within five years before cancer diagnosis, varying by age (3% for age<50 versus 40% for ≥80). Of those without pre-existing CVD (n=281,669), 27%(n=76,924) had post-cancer CVD, with the highest age-standardised incidence rates in pancreatic cancer (716 per 10,000 person-years), followed by lung (657). The median follow-up period was 6·8 years with an interquartile range: 2·1-10·3· The sHR of pre-existing CVD for cancer mortality ranged from 0·99 (95% CI: 0·85-1·13) in cancer of kidney to 1·81(95%CI=1·71-1·91) in lymphoma, and for cardiovascular mortality, 1·98 (1·78-2·18) in lymphoma to 4·74 (4·39-5·09) in pancreatic cancer. The sHR of post-cancer CVD for cancer mortality, ranging from 0·87(95%CI:0·69-1·05) in liver cancer to 2·33(95%CI=2·04-2·62) in cervical cancer and cardiovascular mortality, ranging from 1·79(95%CI: 1·69-1·89) in melanoma to 3·39, 95%CI=2·90-3·88) in liver cancer.

 

Interpretation: CVD is prevalent both before and after cancer diagnosis, with strong relations to increased cancer, cardiovascular and all-cause mortality. Population-based strategies to strengthen holistic survivorship care and address key risk factors are essential to improve both cancer and cardiovascular outcomes.