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Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis

PURPOSE: Existing research hints that people living with and beyond cancer are at an increased risk of stroke. However, there is insufficient evidence to appropriately inform guidelines for specific stroke prevention or management for cancer patients. We conducted a systematic review and meta-analys...

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Autores principales: Turner, Melanie, Murchie, Peter, Derby, Sarah, Ong, Ariel Yuhan, Walji, Lauren, McLernon, David, Macleod, Mary-Joan, Adam, Rosalind
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9630245/
https://www.ncbi.nlm.nih.gov/pubmed/34739710
http://dx.doi.org/10.1007/s11764-021-01122-7
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author Turner, Melanie
Murchie, Peter
Derby, Sarah
Ong, Ariel Yuhan
Walji, Lauren
McLernon, David
Macleod, Mary-Joan
Adam, Rosalind
author_facet Turner, Melanie
Murchie, Peter
Derby, Sarah
Ong, Ariel Yuhan
Walji, Lauren
McLernon, David
Macleod, Mary-Joan
Adam, Rosalind
author_sort Turner, Melanie
collection PubMed
description PURPOSE: Existing research hints that people living with and beyond cancer are at an increased risk of stroke. However, there is insufficient evidence to appropriately inform guidelines for specific stroke prevention or management for cancer patients. We conducted a systematic review and meta-analysis to describe and quantify stroke incidence in people living with and beyond cancer. METHODS: Medline, CINAHL, and EMBASE were searched for epidemiological studies comparing stroke incidence between cancer and non-cancer patients. Reviewers independently extracted data; random-effects meta-analyses and quality assessment were performed. RESULTS: Thirty-six studies were narratively synthesised. Meta-analysis was conducted using seven studies. Methodological quality was high for most studies. Study populations were heterogeneous, and the length of follow-up and risk factors varied. There was a variation in risk between different cancer types and according to stroke type: pancreatic (HR 2.85 (95% CI 2.43–3.36), ischaemic) (HR 2.28 (95% CI 1.43–3.63), haemorrhagic); lung (HR 2.33 (95% CI 1.63–3.35), ischaemic) (HR 2.14 (95% CI 1.45–3.15), haemorrhagic); and head and neck (HR 1.54 (95% CI 1.40–1.69), haemorrhagic) cancers were associated with significantly increased incidence of stroke. Risk is highest within the first 6 months of diagnosis. Narrative synthesis indicated that several studies also showed significantly increased incidence of stroke in individuals with colorectal cancer, breast cancer, ovarian cancer, nasopharyngeal cancer, leukaemia, and myeloma, and those who have received radiotherapy for head and neck cancers and platinum-based chemotherapy may also have higher stroke incidence. CONCLUSIONS: Stroke incidence is significantly increased after diagnosis of certain cancers. IMPLICATIONS FOR CANCER SURVIVORS: Cardiovascular risk should be assessed during cancer survivorship care, with attention to modifying shared cancer/cardiovascular risk factors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11764-021-01122-7.
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spelling pubmed-96302452022-11-04 Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis Turner, Melanie Murchie, Peter Derby, Sarah Ong, Ariel Yuhan Walji, Lauren McLernon, David Macleod, Mary-Joan Adam, Rosalind J Cancer Surviv Review PURPOSE: Existing research hints that people living with and beyond cancer are at an increased risk of stroke. However, there is insufficient evidence to appropriately inform guidelines for specific stroke prevention or management for cancer patients. We conducted a systematic review and meta-analysis to describe and quantify stroke incidence in people living with and beyond cancer. METHODS: Medline, CINAHL, and EMBASE were searched for epidemiological studies comparing stroke incidence between cancer and non-cancer patients. Reviewers independently extracted data; random-effects meta-analyses and quality assessment were performed. RESULTS: Thirty-six studies were narratively synthesised. Meta-analysis was conducted using seven studies. Methodological quality was high for most studies. Study populations were heterogeneous, and the length of follow-up and risk factors varied. There was a variation in risk between different cancer types and according to stroke type: pancreatic (HR 2.85 (95% CI 2.43–3.36), ischaemic) (HR 2.28 (95% CI 1.43–3.63), haemorrhagic); lung (HR 2.33 (95% CI 1.63–3.35), ischaemic) (HR 2.14 (95% CI 1.45–3.15), haemorrhagic); and head and neck (HR 1.54 (95% CI 1.40–1.69), haemorrhagic) cancers were associated with significantly increased incidence of stroke. Risk is highest within the first 6 months of diagnosis. Narrative synthesis indicated that several studies also showed significantly increased incidence of stroke in individuals with colorectal cancer, breast cancer, ovarian cancer, nasopharyngeal cancer, leukaemia, and myeloma, and those who have received radiotherapy for head and neck cancers and platinum-based chemotherapy may also have higher stroke incidence. CONCLUSIONS: Stroke incidence is significantly increased after diagnosis of certain cancers. IMPLICATIONS FOR CANCER SURVIVORS: Cardiovascular risk should be assessed during cancer survivorship care, with attention to modifying shared cancer/cardiovascular risk factors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11764-021-01122-7. Springer US 2021-11-05 2022 /pmc/articles/PMC9630245/ /pubmed/34739710 http://dx.doi.org/10.1007/s11764-021-01122-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review
Turner, Melanie
Murchie, Peter
Derby, Sarah
Ong, Ariel Yuhan
Walji, Lauren
McLernon, David
Macleod, Mary-Joan
Adam, Rosalind
Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis
title Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis
title_full Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis
title_fullStr Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis
title_full_unstemmed Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis
title_short Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis
title_sort is stroke incidence increased in survivors of adult cancers? a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9630245/
https://www.ncbi.nlm.nih.gov/pubmed/34739710
http://dx.doi.org/10.1007/s11764-021-01122-7
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