BACKGROUND:Accurate assessment of mortality, bleeding, and atherothrombotic risk in patients with cancer and acute coronary syndrome could inform novel personalised treatment strategies, but no standardised tools for this purpose exist. We aimed to develop and validate a clinically applicable risk score for mortality, bleeding, and ischaemic events in patients with cancer and acute coronary syndrome. METHODS:In this model development and validation study, we obtained data for 1 017 759 patients who presented with acute coronary syndrome in England, UK (n=815 170; 36 771 with cancer), Sweden (n=194 059; 10 262 with cancer), and Switzerland (n=8530; 203 with cancer) between Jan 1, 2004, and Aug 8, 2023. Machine learning models were developed to predict all-cause mortality, major bleeding events, and ischaemic events, defined as a composite of cardiovascular death, myocardial infarction, and ischaemic stroke, in patients with cancer and acute coronary syndrome from England in a competing risks framework with a prediction horizon of 6 months. Final models (the ONCO-ACS score) were externally validated in geographically distinct held out datasets from the English Midlands, Sweden, and Switzerland. FINDINGS:Patients with cancer and with acute coronary syndrome were characterised by high rates of mortality (cumulative incidence 27·8% [95% CI 27·3-28·3]), major bleeding (7·3% [7·0-7·5]), and ischaemic events (16·1% [15·7-16·4]) and had a distinct risk profile. The ONCO-ACS score was informed by a single set of variables: tumour type, time since cancer diagnosis, metastatic disease, age, haemoglobin, heart rate, estimated glomerular filtration rate, BMI, Killip class, cardiac arrest, and major bleed within 6 months. Accounting for traditional and cancer-related risk factors, ONCO-ACS showed a time-dependent area under the receiver operating characteristic curve (tAUC) at 6 months of 0·84 (0·83-0·85) for all-cause mortality, 0·70 (0·68-0·73) for major bleeding, and 0·79 (0·78-0·81) for ischaemic events on internal validation. On external validation, ONCO-ACS achieved similar performance for all-cause mortality (tAUC at 6 months 0·84 [0·82-0·85] for the English Midlands, 0·80 [0·79-0·82] for Sweden, and 0·83 [0·76-0·91] for Switzerland), major bleeding events (0·70 [0·67-0·74] for the English Midlands, 0·67 [0·65-0·70] for Sweden, and 0·74 [0·57-0·91] for Switzerland), and ischaemic events (0·76 [0·74-0·78] for the English Midlands, 0·70 [0·69-0·72] for Sweden, and 0·73 [0·61-0·86] for Switzerland). ONCO-ACS was well calibrated and decision curve analyses suggested favourable clinical utility. Applying ONCO-ACS to current guidelines suggests that most patients with cancer and acute coronary syndrome qualify for invasive management and long dual antiplatelet therapy using clopidogrel. INTERPRETATION:The ONCO-ACS score provides a validated practical tool for predicting mortality, bleeding, and ischaemic risk in patients with cancer and acute coronary syndrome. Combined assessment of competing outcome risks could facilitate balancing treatment benefits and harms. FUNDING:British Heart Foundation, Cancer Research UK, Swiss Heart Foundation, University of Zurich Foundation, Kurt-Senta-Herrmann Foundation, Theodor-Ida-Herzog-Egli Foundation, Foundation for Cardiovascular Research-Zurich Heart House, Swedish ALF Research Funds.

BACKGROUND:Fluoropyrimidine chemotherapy is administered first-line for many gastrointestinal cancers. However, patients with cardiovascular disease commonly receive alternative treatment due to cardiotoxicity concerns. OBJECTIVES:This study sought to assess the risks of all-cause mortality and acute cardiovascular events with fluoropyrimidine treatment. METHODS:We conducted an observational cohort study applying a target trial emulation framework to linked national cancer, cardiac, and hospitalization registry data from the Virtual Cardio-Oncology Research Initiative. Adults diagnosed with tumors eligible for fluoropyrimidine-based chemotherapy as first-line therapy were included. All-cause mortality and a composite of hospitalization for acute cardiovascular events (acute coronary syndrome, heart failure, cardiac arrhythmia, cardiac intervention, cardiac arrest, and cardiac death) were compared in patients treated with fluoropyrimidine-based chemotherapy vs alternative management. Adjusted, weighted pooled logistic regression models were used to estimate the 1-year risk difference (RD). RESULTS:Among 103,110 patients (mean age 69.7 years, 59% male), the absolute risk of death at 1 year was significantly lower in fluoropyrimidine-treated patients (RD: -7.7%; 95% CI: -8.7% to -6.7%) with a small increased risk of acute cardiovascular events (RD: 0.9%; 95% CI: 0.0% to 1.9%). This was primarily due to arrhythmias (RD: 0.8%; 95% CI: 0.1% to 1.6%) and cardiac arrest (RD: 0.3%; 95% CI: 0.1% to 0.5%), with no increased risk of acute coronary syndromes including in the subgroup of patients with pre-existing coronary artery disease. CONCLUSIONS:The markedly improved overall survival with fluoropyrimidines in patients with gastrointestinal cancer significantly outweighs the small risk of cardiac arrhythmia and arrest. Oncologists should take this into consideration for decision making to avoid undue clinical conservatism, particularly in patients with cardiovascular disease.

BACKGROUND:Determining the most appropriate treatment in patients with cancer with an acute myocardial infarction (MI) can be challenging. Optimal management requires an understanding of bleeding risk which may be different in this population. This study aimed to investigate the bleeding risk among patients with MI with and without cancer, in the first and second year post-MI. METHODS:Patients with MI, with and without cancer were identified from a national cardio-oncology database from England between 2006 and 2019. The outcome was a presentation to hospital for a major bleeding event, with patients followed for a maximum of 24 months. Inverse probability weighting was used to compare cancer and non-cancer cohorts in time-to-event analyses. RESULTS:587 279 patients with MI were identified, 9820 (1.7%) had cancer and 577 459 (98.3%) did not. Colorectal, prostate, breast, lung and bladder cancer were the most common types of cancer. The rate of hospital presentation for bleeding in the first year post-MI was higher in patients with cancer than the non-cancer reference population (HR: 1.53, 95% CI 1.45 to 1.62, p<0.001). 506 280 patients with MI were followed up in the second year post-MI. 5666 (1.1%) had cancer and 500 614 (98.9%) did not. The bleeding rate in patients with MI with cancer remained elevated in the second year post-MI (HR: 1.42, 95% CI 1.29 to 1.56, p<0.001). There were marked differences in bleeding between cancer types. CONCLUSION:In this real-world observational study, patients with cancer had an increased bleeding risk in the first year post-MI which decreased but persisted in the second year after MI. Bleeding risk in patients with cancer must be carefully assessed post-MI.

The National Optimal Lung Cancer Pathway (NOLCP) was introduced by the NHS to improve timelier diagnosis and staging, enabling patients to progress rapidly to optimal treatment. While care pathways can be streamlined, contextual factors may compromise patient engagement with their care. Northeast London is ethnically diverse and highly deprived; two factors associated with difficulty navigating care systems and increased cancer mortality. This study aims to explore how patient and carer characteristics, and factors related to their location, interact to influence patients' capability, opportunity, and motivation to engage with the NOLCP and improve patient outcomes.

AIMS:Programmed cell death ligand 1 (PD-L1) expression, used universally to predict response of non-small cell lung cancer (NSCLC) to immune-modulating drugs, is a fragile biomarker due to biological heterogeneity and challenges in interpretation. The aim of this study was to assess current PD-L1 testing practices in the UK, which may help to define strategies to improve its reliability and consistency. METHODS:A questionnaire covering NSCLC PD-L1 testing practice was devised and members of the Association of Pulmonary Pathologists were invited to complete this online. RESULTS:Of 44 pathologists identified as involved in PD-L1 testing, 32 (73%) responded. There was good consistency in practice and approach, but there was wide variability in the distribution of PD-L1 scoring. Although the proportions of scores falling into the three groups (negative, low and high) defined by the 1% and 50% 'cut-offs' (38%, 33% and 27%, respectively) reflect the general experience, the range within each group was wide at 23-70%, 10-60% and 15-36%, respectively. CONCLUSIONS:There is inconsistency in the crucial endpoint of PD-L1 testing of NSCLC, the expression score that guides management. Addressing this requires formal networking of individuals and laboratories to devise a strategy for its reduction.

Abstract Introduction Cancer multi-disciplinary team meetings (MDTM) assemble clinical experts to make diagnostic and treatment recommendations. MDTMs can take place in person, virtually, or in a hybrid format. Virtual and hybrid MDTMs have been in use for over two decades. This systematic scoping review aims to map the evidence on virtual and hybrid MDTM formats over time, providing insights into their quality, and the facilitators and barriers to their effective delivery. Methods The PRISMA scoping review checklist has been followed. A systematic search of PubMed, PsychINFO, and Embase between 1990–2023 identified 9399 records. These were independently screened by two researchers to identify primary research of any design that assessed quality or effectiveness of cancer VMDTMs. Results were narratively synthesised. Results Eight quantitative, two qualitative and three mixed-methods studies were included. All were observational and most were retrospective (n = 8). Varied outcome measures were used to evaluate meeting quality, including treatment recommendations, survival, time from diagnosis, and overall attendance. VMDTMs were superior (N = 6) or sometimes equivalent (N = 4) to face-to-face meetings. Studies identified implementation factors critical to their effective delivery, including internet-stability and chairing. Conclusion The heterogeneous literature suggests VMDTMs offer some benefits over face-to-face meetings. Training and infrastructure are key to prevent risks to patient safety. A definitive comparative evaluation is needed to inform best practice.

People with lung cancer, and those who support them, require clear and consistent communication from their healthcare providers to support their engagement in diagnostic and treatment pathways. No systematic review exists that reports on people's qualitative experiences surrounding the communication of a lung cancer diagnosis and subsequent treatment options. This review aimed to identify and synthesise qualitative evidence surrounding patients', carers', and healthcare professionals' experiences of communicating a lung cancer diagnosis and treatment.

Purpose To synthesize the qualitative literature exploring the experiences of people living with lung cancer in rural areas. Methods Searches were performed in MEDLINE, CINAHL, and PsycINFO. Articles were screened independently by two reviewers against pre-determined eligibility criteria. Data were synthesized using Thomas and Harden’s framework for the thematic synthesis of qualitative research. The CASP qualitative checklist was used for quality assessment and the review was reported in accordance with the ENTREQ and PRISMA checklists. Results Nine articles were included, from which five themes were identified: (1) diagnosis and treatment pathways, (2) travel and financial burden, (3) communication and information, (4) experiences of interacting with healthcare professionals, (5) symptoms and health-seeking behaviors. Lung cancer diagnosis was unexpected for some with several reporting treatment delays and long wait times regarding diagnosis and treatment. Accessing treatment was perceived as challenging and time-consuming due to distance and financial stress. Inadequate communication of information from healthcare professionals was a common concern expressed by rural people living with lung cancer who also conveyed dissatisfaction with their healthcare professionals. Some were reluctant to seek help due to geographical distance and sociocultural factors whilst others found it challenging to identify symptoms due to comorbidities. Conclusions This review provides a deeper understanding of the challenges faced by people with lung cancer in rural settings, through which future researchers can begin to develop tailored support to address the existing disparities that affect this population.

Abstract Background Lung cancer is the third most common cancer in the UK and the leading cause of cancer mortality globally. NHS England guidance for optimum lung cancer care recommends management and treatment by a specialist team, with experts concentrated in one place, providing access to specialised diagnostic and treatment facilities. However, the complex and rapidly evolving diagnostic and treatment pathways for lung cancer, together with workforce limitations, make achieving this challenging. This place-based, behavioural science-informed qualitative study aims to explore how person-related characteristics interact with a person’s location relative to specialist services to impact their engagement with the optimal lung pathway, and to compare and contrast experiences in rural, coastal, and urban communities. This study also aims to generate translatable evidence to inform the evidence-based design of a patient engagement intervention to improve lung cancer patients’ and informal carers’ participation in and experience of the lung cancer care pathway. Methods A qualitative cross-sectional interview study with people diagnosed with lung cancer < 6 months before recruitment (in receipt of surgery, radical radiotherapy, or living with advanced disease) and their informal carers. Participants will be recruited purposively from Barts Health NHS Trust and United Lincolnshire Hospitals NHS Trusts to ensure a diverse sample across urban and rural settings. Semi-structured interviews will explore factors affecting individuals’ capability, opportunity, and motivation to engage with their recommended diagnostic and treatment pathway. A framework approach, informed by the COM-B model, will be used to thematically analyse facilitators and barriers to patient engagement. Discussion The study aligns with the current policy priority to ensure that people with cancer, no matter where they live, can access the best quality treatments and care. The evidence generated will be used to ensure that lung cancer services are developed to meet the needs of rural, coastal, and urban communities. The findings will inform the development of an intervention to support patient engagement with their recommended lung cancer pathway. Protocol registration The study received NHS Research Ethics Committee (Ref: 23/SC/0255) and NHS Health Research Authority (IRAS ID 328531) approval on 04/08/2023. The study was prospectively registered on Open Science Framework (16/10/2023; https://osf.io/njq48 ).

There are wide variations and inequalities in lung cancer care across the UK, but most research has focused on improving the quality of clinical services and less on individual-related factors. There is evidence to suggest that rural people with lung cancer may experience unique inequalities in care compared to their urban counterparts. Lincolnshire has some of the most deprived parts of the UK, particularly in rural and coastal areas, where people face considerable barriers to engaging with, and accessing cancer care. This study explores how rural patient and carer characteristics, and factors related to their location, interact to influence patients' capability, opportunity, and motivation to engage with their recommended treatment pathway.

Introduction Cardiovascular disease and cancer are common causes of morbidity and mortality. Advancements in treatment strategies for both diseases have resulted in a growing population who live with both conditions. Myocardial infarction (MI) represents approximately 20% of all cardiovascular disease admissions in cancer patients and 10% of patients who present with an acute MI have cancer. Managing MI patients with cancer require careful balancing of their ischaemic and bleeding risks. While dual antiplatelet therapy (DAPT) increases a patient's bleeding risk, cancer patients are at further increased risk due to a range of direct and indirect cancer effects. While our recent studies demonstrated an increased bleeding risk in cancer patients in the 1st year after MI (the period of intensive APT), it is currently not known if this risk is sustained beyond this period. VICORI is the world's first whole-country cardio-oncology research platform, linking data from the National Cancer Registration and Analysis Service, National Institute for Cardiovascular Outcomes Research and Hospital Episode Statistics. We investigated the risk of bleeding among MI patients in the 2nd year post-MI, where a large majority of patients would have completed a course of DAPT, stratified by the presence or absence of cancer. Methods In this retrospective observational study, we investigated the risk of bleeding following an MI between 2006–2019, in patients with and without cancer. Cancer was defined as a diagnosis of cancer in the 1-year preceding MI. Patients who lived past the 1st year after MI were followed-up from 12 to 24 months after their MI. We used inverse probability weighting based on propensity scores to produce a balanced cohort of patients with and without cancer. Cox proportional hazard and flexible parametric modelling were used to investigate cancer as a predictor of bleeding. Subgroup analyses were performed on stent status, MI and cancer type. Results Of 506280 patients presenting with MI, 5666 (1.1%) had cancer while 500614 (98.9%) did not. Prostate (n=1377), colorectal (n=1024), lung (n=490), breast (n=448) and bladder (n=334) cancers were among the most common types of cancers. The rate (hazard) of bleeding in MI was higher in patients with cancer in the 2nd year post-MI (HR:1.42, 95%CI 1.29–1.56) compared to those without. From the flexible parametric survival analysis, the risk of bleeding in cancer patients in the 2nd year post-MI was lower compared to the 1st year but remained statistically significant compared to patients without cancer. Conclusion In this large real-world study, cancer patients have a persistent, increased bleeding risk beyond the 1-year post-MI period, compared to those without cancer, and this risk differed by type of cancer. Further work is needed to identify specific patient characteristics in each patient sub-group which alters one's ischaemic or bleeding risk so they can be balanced favourably with personalised strategies. Conflict of Interest None

INTRODUCTION:In the UK, the National Cancer Plan (2000) requires every cancer patient's care to be reviewed by a multidisciplinary team (MDT). Since the introduction of these guidelines, MDTs have faced escalating demands with increasing numbers and complexity of cases. The COVID-19 pandemic has presented MDTs with the challenge of running MDT meetings virtually rather than face-to-face.This study aims to explore how the change from face-to-face to virtual MDT meetings during the COVID-19 pandemic may have impacted the effectiveness of decision-making in cancer MDT meetings and to make recommendations to improve future cancer MDT working based on the findings.METHODS AND ANALYSIS:A mixed-methods study with three parallel phases:Semistructured remote qualitative interviews with ≤40 cancer MDT members.A national cross-sectional online survey of cancer MDT members in England, using a validated questionnaire with both multiple-choice and free-text questions.Live observations of ≥6 virtual/hybrid cancer MDT meetings at four NHS Trusts.Participants will be recruited from Cancer Alliances in England. Data collection tools have been developed in consultation with stakeholders, based on a conceptual framework devised from decision-making models and MDT guidelines. Quantitative data will be summarised descriptively, and χ2 tests run to explore associations. Qualitative data will be analysed using applied thematic analysis. Using a convergent design, mixed-methods data will be triangulated guided by the conceptual framework.The study has been approved by NHS Research Ethics Committee (London-Hampstead) (22/HRA/0177). The results will be shared through peer-reviewed journals and academic conferences. A report summarising key findings will be used to develop a resource pack for MDTs to translate learnings from this study into improved effectiveness of virtual MDT meetings.The study has been registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/D2NHW).

Introduction Cardiovascular disease and cancer are common causes of morbidity and mortality. Significant advancements in treatment strategies for both disease entities have resulted in a growing population who live with both conditions. Myocardial infarction (MI) represents approximately 20% of all cardiovascular disease admissions in cancer patients and 10% of patients who present with an acute MI has cancer. Bleeding is a major concern in patients with cancer and an acute coronary syndrome (ACS). While dual antiplatelet therapy (DAPT) increases a patient’s bleeding risk, cancer patients are at a further increased risk. Cancer is a recognised risk factor associated with an increased bleeding risk after percutaneous coronary intervention (PCI), but blood dyscrasias, liver disease and multiple long-term conditions – all common to cancer patients – further exacerbate this risk. Prescribing DAPT post-ACS and post-PCI remains a challenge when balancing ischaemic and bleeding risks in this population. The VICORI database is the world’s first whole-country cardio-oncology research platform, linking data from the National Cancer Registration and Analysis Service, National Institute for Cardiovascular Outcomes Research and Hospital Episode Statistics. We aim to investigate the risk of hospitalisation for bleeding among ACS patients stratified by presence or absence of cancer. Methods This is an observational cohort study using linked data from the VICORI database. We investigated the risk of hospitalisation for bleeding following an ACS, in patients with and without cancer, identified between 2006–2019. Patients were followed up for one year from the date of their ACS. We used inverse probability weighting based on propensity scores to produce a balanced cohort of patients with and without cancer. Subgroup analyses were performed on patients with ST and non-ST-elevation MI alongside coronary stenting. Results Of 608,771 patients presenting with ACS, 9861 (1.6%) had cancer while 598,910 (98.4%) did not. Prostate (n=1753, 17.8%), colorectal (n=1548, 15.7%), lung (n=1543, 15.7%) and breast (n=607, 6.2%) cancers were among the most common types of cancers. Relating to PCI, cancer patients received stents in only 35.4% (n=3,489) of cases, while non-cancer patients received stents in 55.5% (n=332,566) of cases. Bleeding events were more prevalent in cancer patients compared to non-cancer patients (n=779, 7.9% vs n=28,016, 4.7%). The rate (hazard) of hospitalisation for bleeding in the first year following ACS was higher in patients with cancer than those without (HR:1.46, 95%CI 1.36 to 1.57). Conclusion In this large real-world observational study, cancer patients had an increased risk of hospitalisation for bleeding after ACS compared to those without. Further work is needed to identify people with cancer who are at a high-risk of bleeding, optimal therapies, and the risk:benefit ratio of bleeding versus subsequent cardiovascular events. Conflict of Interest None

The June highlights from the Circulation family of journals span a fascinating range of cardiovascular medicine.The findings of a multicenter study of electrophysiology studies before pulmonic valve replacements in patients with tetralogy of Fallot are described in Circulation: Arrhythmia and Electrophysiology.The associations of epigenetic aging with a variety of clinical characteristics are reported in Circulation: Genomic and Precision Medicine.Differences in clinical outcomes by sex for left ventricular assist device recipients are reported in Circulation: Heart Failure.The effects of a previous cancer diagnosis on outcomes after acute myocardial infarction are presented in Circulation: Cardiovascular Quality and Outcomes.The association of left atrial function with recurrent atrial fibrillation after ablation is described in Circulation: Cardiovascular Imaging.An observational analysis of percutaneous coronary intervention versus conservative management for spontaneous coronary artery dissection is reported in Circulation: Cardiovascular Interventions.

Aims Currently, little evidence exists on survival and quality of care in cancer patients presenting with acute heart failure (HF). The aim of the study is to investigate the presentation and outcomes of hospital admission with acute HF in a national cohort of patients with prior cancer. Methods and results This retrospective, population-based cohort study identified 221 953 patients admitted to a hospital in England for HF during 2012-2018 (12 867 with a breast, prostate, colorectal, or lung cancer diagnosis in the previous 10 years). We examined the impact of cancer on (i) HF presentation and in-hospital mortality, (ii) place of care, (iii) HF medication prescribing, and (iv) post-discharge survival, using propensity score weighting and model-based adjustment. Heart failure presentation was similar between cancer and non-cancer patients. A lower percentage of patients with prior cancer were cared for in a cardiology ward [-2.4% age point difference (ppd) (95% CI -3.3, -1.6)] or were prescribed angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists (ACEi/ARB) for heart failure with reduced ejection fraction [-2.1 ppd (-3.3, -0.9)] than non-cancer patients. Survival after HF discharge was poor with median survival of 1.6 years in prior cancer and 2.6 years in non-cancer patients. Mortality in prior cancer patients was driven primarily by non-cancer causes (68% of post-discharge deaths). Conclusion Survival in prior cancer patients presenting with acute HF was poor, with a significant proportion due to non-cancer causes of death. Despite this, cardiologists were less likely to manage cancer patients with HF. Cancer patients who develop HF were less likely to be prescribed guideline-based HF medications compared with non-cancer patients. This was particularly driven by patients with a poorer cancer prognosis.

Background In England, as for many countries, there are geographical variations in treatment uptake and outcomes for patients with early breast cancer (EBC). It is important such inequalities are addressed. The co-existence of cardiovascular disease (CVD) in patients with early breast cancer (EBC) may complicate treatment choices, lead to deviations from standard of care, and be associated with worse cancer and CVD outcomes. Social deprivation is also associated with increased incidence of co-morbidities, reduced cancer treatment rates, and worse cancer survival. If there are regional differences in rates of CVD/co-morbidities and social deprivation these may explain observed differences in treatment uptake and cancer outcomes in EBC. Therefore, in this analysis we evaluated rates of CVD and social deprivation in a large population of patients with EBC in 20 English Cancer Alliances. Methods Cancer registry data as part of The Virtual Cardio-Oncology Research Initiative (VICORI) were used to identify patients diagnosed with stage I-III breast cancer diagnosed between 2013 - 2018 in England. National data (hospital records and national cardiovascular audit databases) were used to describe CVD prevalence (CVDp), Index of Multiple Deprivation (IMD), and Charlson Comorbidity Index (CCI). Patient, disease, tumour, and treatment characteristics were allocated into Cancer Alliance tertiles according to CVDp (minimum (< 33.3rd percentile); middle (33.3rd – 66.6th percentile); maximum (>66.6th percentile)) with approximately equal patient numbers in each group. The disease burden was depicted in bar charts and regional variation as heat maps of England. The percentage of patients in the most deprived quintile of income domain of the IMD were plotted. Funnel plots were used to investigate variations in regional CVD rates based on a logistic regression model. Results Data from 226,516 patients with stage I-IIIA breast cancer with a mean age of 62.5 (+/- 13.7) were included in the analysis. 78,833 patients were assigned to the minimum (37.0%; 95% CI 36.7 – 37.2), 74,443 to the middle (35.5%; 95% CI 35.3 – 35.7), and 73,240 to the maximum (34.7%; 95% CI 34.5 – 34.9) tertile. Geographical variation between Cancer Alliances was demonstrated for CVDp (6% - 9.5%), IMD (2%- 30%), and CCI  4 (8.2% - 9.5%). Variation of CVDp revealed a South/North gradient between Cancer Alliances towards higher percentage, with centrifugal tendency from London. These findings were consistent with a similar pattern seen for variation in IMD quintiles with higher prevalence of most socioeconomic deprived patients located in cancer alliances in the North compared to the South of England. Regional variation was less obvious for CCI. After adjusting for age, TNM stage, IMD, and CCI, differences in the standardised CVD ratio persisted for some cancer alliances suggesting that other factors than those adjusted for are likely accountable for the higher CVDp seen in some Cancer Alliances. An adjusted ordinal logistic regression model demonstrated that older age (aged >75), white ethnicity, and social deprivation were associated with a higher risk of CVDp (p< 0.001). Conclusions This study highlights significant geographical variation of social deprivation, CVDp, and other comorbidities in early breast cancer patients in England which may contribute to the variability in treatment received and breast cancer survival in different regions within the country. Citation Format: Jasmin V Waterhouse, Catherine A. Welch, Nicolo M.L. Battisti, David Adlam, Michael J. Sweeting, Lizz Paley, Paul Lambert, John E. Deanfield, Mark de Belder, Michael D Peake, Alistair Ring. Geographical variation of social deprivation, cardiovascular and other comorbidities in 226,516 patients with early breast cancer in England: results from a National Registry Dataset Analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-04.

BACKGROUND Although a common challenge for patients and clinicians, there is little population-level evidence on the prevalence of cardiovascular disease (CVD) in individuals diagnosed with potentially curable cancer.OBJECTIVES We investigated CVD rates in patients with common potentially curable malignancies and evaluated the associations between patient and disease characteristics and CVD prevalence.METHODS The study included cancer registry patients diagnosed in England with stage I to III breast cancer, stage I to III colon or rectal cancer, stage I to III prostate cancer, stage Ito IIIA non-small-cell lung cancer, stage Ito IV diffuse large B-cell lymphoma, and stage I to IV Hodgkin lymphoma from 2013 to 2018. Linked hospital records and national CVD databases were used to identify CVD. The rates of CVD were investigated according to tumor type, and associations between patient and disease characteristics and CVD prevalence were determined.RESULTS Among the 634,240 patients included, 102,834 (16.2%) had prior CVD. Men, older patients, and those living in deprived areas had higher CVD rates. Prevalence was highest for non-small-cell lung cancer (36.1%) and lowest for breast cancer (7.7%). After adjustment for age, sex, the income domain of the Index of Multiple Deprivation, and Charlson comorbidity index, CVD remained higher in other tumor types compared to breast cancer patients.CONCLUSIONS There is a significant overlap between cancer and CVD burden. It is essential to consider CVD when evaluating national and international treatment patterns and cancer outcomes.(c) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).