Cardiac risk, outcomes, and management among older adults with stage I-II non-small cell lung cancer undergoing stereotactic body radiation therapy.

INTRODUCTION

Older adults with early-stage non-small cell lung cancer (NSCLC) undergoing stereotactic body radiation therapy (SBRT) have a high competing risk of adverse cardiac events, but adherence to guideline-directed cardiovascular care remains unclear. This study examined cardiovascular risk, management, and outcomes among older adults with early-stage NSCLC receiving SBRT.

MATERIALS AND

METHODS

This retrospective cohort study included patients aged ≥65 with early-stage NSCLC who completed SBRT between 2019 and 2023 at our institution. The following were assessed: (1) 10-year atherosclerotic cardiovascular disease (ASCVD) Framingham risk score, (2) baseline rates of guideline-directed management for hypertension, hyperlipidemia, and diabetes, (3) primary care and cardiology visits in the year before and after SBRT, and (4) competing risk-adjusted cumulative incidence of major adverse cardiac events (MACE).

RESULTS

Among 330 patients (median age 77.1 years, 61.8% female), 98.5% (n = 325) had cardiovascular comorbidities, including hypertension (88.2%, n = 291) and hyperlipidemia (86.4%, n = 285). At SBRT initiation, 30.6% (n = 101) had prior ASCVD, and 91.8% (n = 303) were at high, or very high risk for future events based on their history or calculated risk score. Following SBRT, at a median follow-up of 21.3 months (IQR 12.8-33.6 months), 17.6% (n = 58) experienced MACE, with a risk-adjusted cumulative incidence at 2 years of 13.0%. Guideline-directed management was infrequent: 45.7% (n = 133) for hypertension, 28.7% (n = 82) for hyperlipidemia, and 30.3% (n = 20) for diabetes. Before and after SBRT, more than half of patients had no primary care or cardiology visits (pre: 54.5%; post: 55.8%).

DISCUSSION: Older adults undergoing SBRT face substantial cardiovascular risk, but many do not receive appropriate preventive care. These findings highlight opportunities for multidisciplinary collaboration to support age-appropriate cardiovascular assessment and care delivery.