Frail patients with breast cancer at risk for heart disease

This study is the first to examine the role of frailty and heart issues among breast cancer patients in real-world clinical settings.

Women undergoing treatments following breast cancer surgery may face a significant risk of heart disease, according to new findings from a research team at the University of Florida. The study found that 20 percent of post-operative breast cancer patients experienced heart problems after receiving secondary treatments such as chemotherapy.

This research indicates that health care providers may need to place greater emphasis on monitoring the heart health of breast cancer patients who are frail or generally in poor health. These patients might benefit from personalized treatment strategies to enhance the safety and efficacy of breast cancer care.

The findings were published in January in JACC CardioOncology, a prestigious journal of the American College of Cardiology.

Large Data for Strong Results

Shuang Yang
Shuang Yang

Conclusions were drawn from an analysis of more than 2,000 patients treated for breast cancer from 2012 to 2022, as identified from the OneFlorida+ Clinical Research Network, a major medical data repository coordinated at the University of Florida. The average patient age was 50.

“Many breast cancer patients are older adults with pre-existing frailty, which limits their ability to tolerate aggressive treatments,” said lead author Shuang Yang, a researcher in UF’s College of Medicine’s Department of Health Outcomes and Biomedical Informatics. “Our ultimate aim is to provide clinicians with actionable insights that guide safer and more effective treatment decisions for breast cancer patients.”

Patients with higher levels of frailty, due to old age or pre-existing conditions, face a higher risk of cardiotoxicity or damage to their hearts. Integrating frailty assessments into routine clinical practice could help healthcare providers identify patients at high risk and tailor treatments to minimize potential harm.

Side Effects on the Heart

Breast cancer is the most common cancer among women. While modern therapies have significantly improved survival rates, they often come with unwanted side effects that can lead to life-threatening heart complications. In this study, the potential complications identified were heart failure, cardiac arrhythmia, cardiomyopathy, and atrial fibrillation or flutter.

Using innovative analytical methods and real-world data, the research team explored details of patient medical histories and treatment outcomes to reflect clinical realities.

This research depended on identifying fully accurate and considerable numbers of breast cancer survivors who had surgery within one year after diagnosis. From this initial group of 24,495 women in the OneFlorida+ network’s database, the researchers narrowed the group to include only those who received additional treatment within one year after surgery.

“This study highlights OneFlorida-plus as a prominent source of real-world data for generating real-world evidence,” said Yi Guo, PhD, FAMIA, anassociate professor in the Department of Health Outcomes and Biomedical Informatics.

Florida Team Effort

Yi-Guo square
Yi Guo, PhD

Lead author Yang is grateful for the support of the OneFlorida+ Clinical Research Network, the Cancer Informatics Shared Resource, and the Florida Breast Cancer Foundation.

Eight of the study’s eleven researchers represent the UF College of Medicine: Shuang Yang, MS, Department of Health Outcomes and Biomedical Informatics (HOBI); Xiwei Lou, MS, HOBI; Mustafa M. Ahmed, MD, Division of Cardiovascular Medicine; Karen C. Daily, DO, Division of Hematology and Oncology; Thomas J. George, MD, Division of Hematology and Oncology; Carl J. Pepine, MD, Division of Cardiovascular Medicine; and Jiang Bian and Yi Guo, PhD, both with HOBI and the Cancer Informatics Shared Resource in the UF Health Cancer Center. Two researchers from the UF Department of Epidemiology in the College of Public Health and Health Professions were Stephen E. Kimmel, MD, and Dejana Braithwaite, PhD, MSC, and one former UF researcher, Dongyu Zhang, PhD, now represents Janssen Research and Development, LLC. 


Citation:

 Shuang Yang, MS Xiwei Lou, MS Mustafa M. Ahmed, MD Stephen E. Kimmel, MD Karen C. Daily, DO Thomas J. George, MD Carl J. Pepine, MD Jiang Bian, PhD Dejana Braithwaite, PhD, MSc Dongyu Zhang, PhD Yi Guo, PhD. 2025. Impact of Pre-Existing Frailty on Cardiotoxicity Among Breast Cancer Patients Receiving Adjuvant Therapy. J Am Coll Cardiol CardioOnc. null2025, 0 (0). https://doi.org/10.1016/j.jaccao.2024.10.012