Radiation-Associated Cancer Rate in Hospitalized Adults With Congenital Heart Disease

Adults with congenital heart disease (CHD) have an increased incidence of radiation-associated cancers of the lung, breast, and liver with higher hospital costs for most cancer types and worse hospital outcomes, according to findings presented at the American Heart Association (AHA) Scientific Sessions 2022, held from November 5^th through 7^th, in Chicago, Illinois.

Researchers sought to investigate if patients with CHD who were repeatedly exposed to low-dose ionizing radiation for diagnosis, treatment, and long-term care management face higher risk for radiation-associated cancers (colon, breast, bladder, liver, lung, leukemia/myeloma, esophageal, ovarian, and stomach). They hypothesized repeated exposure would create greater risk.

They conducted a retrospective review of a national administrative database (Vizient) using ICD-10 codes for moderate or severe CHD and radiation-associated cancers. Data were from December 2018 to December 2021 that included 34,793 CHD admissions (58.1% women) of whom 6.4% had radiation-associated cancer. They included almost 25 million admissions not related to CHD (56.8% women) of whom 11.2% had radiation-associated cancer (P <.001).

The researchers observed that patients with CHD and radiation-associated cancer were younger than patients without CHD who had radiation-associated cancer (mean age, 66 years [range, 55-74] vs mean age 68 years [range, 59-75]). They noted that patients with CHD and radiation-associated cancer had longer length of stay (8.13 [SD, 11.51] vs 6.68 [SD, 8,47]), higher complications (6.7% vs 5.0%), costs ($20,796 [SD, $43,223] vs $12,983 [SD, $21,946]), and in-hospital mortality (5.6% vs 4.6%). The researchers also noted that race/ethnicity was balanced between the groups without statistical significance.

They found higher rates of liver, lung, and breast cancer in patients with CHD and radiation-associated cancer (all P <.05), higher costs for all patients with CHD and radiation-associated cancers except esophageal, and lower rates of bladder, colon, esophagus, ovarian, stomach, and leukemia/multiple myeloma cancer in patients with CHD and radiation-associated cancers when compared with patients without CHD who had radiation-associated cancers.

 “This national database review showed increased incidence of some types of RAC [radiation-associated cancers] (lung, liver, and breast) in adults with CHD, with worse hospital outcomes and higher costs for several cancer types,” the study authors wrote. “These findings also highlight the importance of adherence to the ‘as low as reasonably achievable’ (ALARA) principle in the care of children and adults with CHD and stresses the importance of imaging modalities that do not use ionizing radiation.”