Abstract
Baseline cardiovascular disease (CVD) has been linked with poorer outcomes for patients with cancer. The precise mechanisms underpinning that are poorly understood but may include reduced treatment receipt. We estimated the association between pre-existing CVD and cancer treatment receipt using population-based cancer registry records. Records of all adults diagnosed with cancer (excluding non-melanoma skin cancer) in Northern Ireland in 2009–2019 were linked with comorbidity and treatment data. The adjusted odds ratios (aOR) of receiving various cancer treatments for patients with previous cardiovascular diagnoses were estimated using multivariable logistic regression, adjusting for established confounders. Subgroup analyses were conducted for combinations of 24 tumour sites, 11 cardiovascular conditions, and 5 cancer treatment modalities. Kaplan-Meier curves and Cox proportional hazards model were used to analyse time to treatment. 81,341 cancer patients were included, with a mean age of 67.1 ± 14.1 years. The most common cancers included were breast (15.8%), lung (14.1%) and colorectal cancer (13.5%). Patients with pre-existing CVD (23.4%) were 30% less likely to receive any cancer treatment than patients without (aOR = 0.70 [95%CI 0.67, 0.73]). This reduction varied between treatment modalities with 30% for chemotherapy (aOR = 0.70 [95%CI 0.67, 0.73]), 28% for radiotherapy (aOR = 0.72 [95%CI 0.66, 0.79]), and 23% for surgery (aOR = 0.77 [95%CI 0.74, 0.80]). Hormone therapy showed no significant overall difference (aOR = 1.02 [95%CI 0.94, 1.11]). At 6 months post-diagnosis, patients with pre-existing CVD had a 14% (0.14 [95%CI 0.13, 0.15]) lower probability of initiating cancer treatment compared to those without. Pre-existing CVD was associated with an overall lower odds of cancer treatment, although the magnitude of this decrement varied according to the primary tumour, treatment modality and the type of CVD. These data present granular population-based insights into the impact of cardiovascular comorbidities on receiving cancer treatment and should be accounted for when reporting survival variations and healthcare policymaking.
Data availability
The datasets generated and/or analysed as part of this study are not publicly available due to the limits of the ethical approval granted to the Northern Ireland Cancer Registry to share patient-level data. Anonymised, non-patient level data can be made available from the corresponding author on reasonable request.
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Acknowledgements
The authors wish to express their gratitude to the staff at the Northern Ireland Cancer Registry, who ensure cancer records are maintained in a way that they are accurate, complete, consistent and useful, since 1994. They also extend their thanks to Duyen Nguyen and Amisha Ashok for their help in running analyses on the registry’s secure computers.
Funding
This study is funded by Heart Research UK [Grant no: TR2438/18/20]. The data were provided by the Northern Ireland Cancer Registry, funded by the Public Health Agency for Northern Ireland.
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HK: conceptualisation, methodology, software, data curation, formal analysis, visualisation, writing - original draft, writing – review and edit. GW: conceptualisation, writing – review and edit. DB: resources, writing – review and edit. AG: conceptualisation, funding acquisition, resources, writing – review and edit. MH: conceptualisation, funding acquisition, writing – review and edit. CON: conceptualisation, methodology, supervision, writing – original draft, writing – review and edit. The authors read and approved the final manuscript.
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The authors declare that they have no competing interests. GW received a speaker fee from Astra Zeneca in 2023.
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This study was conducted on anonymised data in accordance with Northern Ireland Cancer Registry (NICR) Confidentiality and Data Protection Policies; therefore informed consent was not required. The NICR obtained ethical approval from the Office for Research Ethics Committees of Northern Ireland (Ref: 20/NI/0132), which covers the work conducted in this study. All methods were carried out in accordance with relevant guidelines and regulations.
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Küçükali, H., Walls, G.M., Bennett, D. et al. The association between pre-existing cardiovascular disease and cancer treatment receipt in a population-based cancer registry. Sci Rep (2026). https://doi.org/10.1038/s41598-026-38529-0
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DOI: https://doi.org/10.1038/s41598-026-38529-0
