Adults who survive childhood cancer have a higher risk of heart disease than the general population, yet they are 80% more likely to be treated for several cardiovascular risk factors: high blood pressure (also known as high blood pressure). ), diabetes and high cholesterol, according to new research published today in Journal of the American Heart AssociationAn open access, peer-reviewed journal of the American Heart Association.
Previous research has shown that due to exposure to chemotherapy and/or radiation, childhood cancer survivors may face a five-fold increased risk of heart disease and death compared to the general population. Several studies have shown that the majority of adult childhood cancer survivors report receiving only general medical care and not those specific to their experience with cancer. Previous research also suggests that cancer survivors are not receiving recommended heart screenings in a timely manner due to limited awareness of future health complications by survivors and health care professionals.
These findings make underdiagnosis and undertreatment significant concerns for the estimated half-million childhood cancer survivors living in the United States.”
Eric J. Chow, MD, MPH, lead study author, associate professor in clinical research and public health sciences, Fred Hutchinson Cancer Center in Seattle
In this study, cardiovascular risk factor undertreatment was defined as a diagnosis of high blood pressure, high cholesterol or diabetes, yet higher than recommended levels of blood pressure, “bad” cholesterol, triglycerides, or blood glucose. (No details are available regarding type 1 or type 2 diabetes diagnosis.)
Participants were recruited from the Childhood Cancer Survivor Study (CCSS), a large study that included cancers diagnosed before the age of 21 between 1970 and 1999 in health care centers in the US and Canada, and who were at least five lived for a year. Between September 2017 and April 2020, researchers recruited US-based CCSS participants from a pool of childhood cancer survivors who were at least 18 years old, free of heart disease or heart failure, who were nine major Americans lived within 50 miles of metropolitan areas (Atlanta). Boston, Denver, Houston, Minneapolis, Philadelphia, Pittsburgh, Seattle and Columbus, Ohio). The recruits were also participating in a separate clinical trial testing the potential of a telehealth-care plan to improve cardiovascular outcomes among childhood cancer survivors. In this group, which consisted of 85% white adults and 57% women, the most common types of cancer were leukemia, lymphoma, and bone cancer.
Researchers measured blood pressure, lipid, glucose and hemoglobin A1c levels in nearly 600 adults (median age 37 years) and obtained similar data on a comparison group of nearly 350 same-age adults without a history of cancer. , The analysis found:
- Cancer survivors were more likely to have high blood pressure (18% versus 11%), abnormal lipid levels (14% versus 4.9%), and diabetes (6.5% versus 3.2%, respectively). ,
- Participants in both groups had similar rates of high blood pressure, high cholesterol, and diabetes: 27.1% among cancer survivors and 26.1% in the comparison group. However, cancer survivors were 80% more likely to have these conditions than their study counterparts.
“Severe heart disease is uncommon in young adults in the general population, which includes childhood cancer survivors, so greater awareness of heart disease risk is important if there is a history of cancer,” Chou said. “Raising awareness among primary care professionals as well as improving survivors’ ability to self-manage their health may reduce increased risks. Special heart disease risk calculators designed for cancer survivors are, and they may be more accurate in predicting future cardiovascular disease risk than risk calculators designed for the general population.”
The analysis also included results from a self-reported questionnaire assessing medical history, such as heart health and treatment; Diet, exercise and other lifestyle habits; and confidence in people’s ability to manage their own health.
Information on a comparison group of peers with no history of childhood cancer came from the 2015–2016 National Health and Nutrition Examination Survey, in which participants standardized health examinations and at-home interviews, similar to those taken by cancer survivors. compared to the questionnaire.
Other findings include:
- The lowest diagnosed and treated heart disease risk factors among cancer survivors were hypertension at 18.9% and lipid disorders at 16.3%.
- Among cancer survivors, men were twice as likely to be underdiagnosed and treated for heart disease risk factors; Whereas overweight or obese survivors were 2–3 times more likely to be underdiagnosed and treated.
- Cancer survivors who had two or more unhealthy lifestyle factors, such as physical inactivity and low consumption of fruits and vegetables, were twice as likely as the comparison group.
The study also found that childhood cancer survivors reported higher self-efficacy – a strong belief in their ability to manage their own health – with a 50% lower risk for the heart disease risk factors studied. was. “This is perhaps not surprising, yet it suggests that efforts to help survivors learn how to take more ownership of their health conditions may help improve long-term outcomes,” Chou said. ” “It has also been shown in patients with other chronic health conditions outside of cancer.”
Limitations of the study are the potential for measurement error and misclassification between cancer survivors and the comparison group due to the one-time health assessment.
American Heart Association
Chow, EJ, and others. (2022) Diagnosis and treatment of modifiable cardiovascular risk factors among childhood cancer survivors. Journal of the American Heart Association. doi.org/10.1161/JAHA.121.024735.