Cardiovascular Diseases And Psychiatric Disorders During The Diagnostic Workup Of Suspected Hematological Malignancy

Abstract

Background

Little attention has been given to the risk of cardiovascular and psychiatric comorbidities during the clinical evaluation of a suspected hematological malignancy.

Methods

Based on Skåne Healthcare Register, we performed a population-based cohort study of 1,527,449 individuals residing during 2005–2014 in Skåne, Sweden. We calculated the incidence rate ratios (IRRs) of cardiovascular diseases or psychiatric disorders during the diagnostic workup of 5495 patients with hematological malignancy and 18,906 individuals that underwent a bone marrow aspiration or biopsy or lymph node biopsy without receiving a diagnosis of any malignancy (“biopsied individuals”), compared to individuals without such experience (i.e., reference).

Results

There was a higher rate of cardiovascular diseases during the diagnostic workup of patients with hematological malignancy (overall IRR, 3.3; 95% CI, 2.9 to 3.8; greatest IRR for embolism and thrombosis, 8.1; 95% CI, 5.2 to 12.8) and biopsied individuals (overall IRR, 4.9; 95% CI, 4.6 to 5.3; greatest IRR for stroke, 37.5; 95% CI, 34.1 to 41.2), compared to reference. Similarly, there was a higher rate of psychiatric disorders during the diagnostic workup of patients with hematological malignancy (IRR, 2.1; 95% CI, 1.5 to 2.8) and biopsied individuals (IRR, 3.1; 95% CI, 2.9 to 3.4). The rate increases were greater around the time of diagnosis or biopsy, compared to thereafter, for both outcomes.

Conclusion

There were higher rates of cardiovascular diseases and psychiatric disorders during the diagnostic workup of a suspected hematological malignancy, regardless of the final diagnosis.

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Keywords:

• hematological malignancy
• cardiovascular diseases
• psychiatric disorders
• diagnostic workup

Acknowledgments

The authors would like to thank the Swedish Cancer Society (no. CAN 2017/322 to F.F.), the Swedish Research Council for Health, Working Life and Welfare (no. 2017-00531 to F.F.), the China Scholarship Council (No. 201407930016 to Q.S., no. 201700260291 to Q.L.) and the Karolinska Institutet (Senior Researcher Award to F.F.).

Disclosure

Therese ML Andersson took part in a private–public collaboration between Karolinska Institutet and Janssen Pharmaceuticals. Fang Fang reports grants from Swedish Cancer Society, Swedish Research Council for Health, Working Life and Welfare, Karolinska Institutet, China Scholarship Council, during the conduct of the study. The authors report no other conflicts of interest in this work.