Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care?
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Individuals diagnosed with high survival cancers will often die of cardiovascular disease (CVD) rather than a recurrence of their cancer, yet CVD risk factors may be overlooked during survivorship care. We assess the prevalence of CVD risk factors among long-term cancer survivors and compare results to survey data from the general population in the same geographic region. We also characterize how often at-risk survivors discuss CVD-related health behaviors with their health care providers.
Survivors (n = 1,582) of breast, prostate, colorectal, and gynecologic cancers, 4–14 years after diagnosis, were recruited from two California cancer registries for a cross-sectional mail survey. We assessed CVD risk factors, including smoking, body mass index, physical inactivity, hypercholesterolemia, hypertension, and diabetes, as well as report of discussions with health care providers about diet, exercise, smoking, and lifestyle change assistance.
With the exception of current smoking, CVD risk factors were more common among survivors than the general adult population. Of survivors, 62.0 % were overweight or obese, 55.0 % reported hypertension, 20.7 % reported diabetes, 18.1 % were inactive, and 5.1 % were current smokers. Compared to white, non-Hispanic survivors, Hispanic (b = 0.37, p = 0.007) and African-American (b = 0.66, p < 0.0001), but not Asian, survivors reported significantly more risk factors. One in three survivors with one or more risk factors for CVD did not report a health promotion discussion with their health care providers.
CVD risk factors are common among long-term survivors, but many at-risk survivors may not discuss lifestyle prevention with their health care team. Primary care and oncology should work together to deliver optimal survivorship care that addresses CVD risk factors, as well as prevalent disease.
Implications for cancer survivors
Cardiovascular disease may compromise cancer survivors’ long-term health and well-being, yet cardiovascular risk factors may be overlooked during survivorship care. We document that CVD risk factors are common among cancers survivors, yet nearly a third of survivors do not report health promotion discussions with their medical teams. Survivors should be aware of their cardiovascular risk factors and initiate discussions with their medical teams about health promotion topics, if appropriate.
- Patnaik J, Byers T, DiGuiseppi C, Dabelea D, Denberg T. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Research. 2011;13:R64. CrossRef
- Shikanov S, Kocherginsky M, Shalhav AL, Eggener SE. Cause-specific mortality following radical prostatectomy. Prostate Cancer Prostatic Dis. 2011;15:106–10. CrossRef
- Fossa SD, Gilbert E, Dores GM, Chen J, McGlynn KA, Schonfeld S, et al. Noncancer causes of death in survivors of testicular cancer. J Natl Cancer Inst. 2007;99:533–44. CrossRef
- Baade PD, Fritschi L, Eakin EG. Non-cancer mortality among people diagnosed with cancer (Australia). Cancer Causes Control. 2006;17:287–97. CrossRef
- Jones LW, Haykowsky MJ, Swartz JJ, Douglas PS, Mackey JR. Early breast cancer therapy and cardiovascular injury. J Am Coll Cardiol. 2007;50:1435–41. CrossRef
- Hawkes AL, Lynch BM, Owen N, Aitken JF. Lifestyle factors associated concurrently and prospectively with co-morbid cardiovascular disease in a population-based cohort of colorectal cancer survivors. Eur J Cancer. 2011;47:267–76. CrossRef
- Wolin KY, Colditz GA. Implementing chronic disease prevention amongst cancer survivors. J Intern Med. 2011;269:85–7. CrossRef
- Haugnes HS, Wethal T, Aass N, Dahl O, Klepp OR, Langberg CW, et al. Cardiovascular risk factors and morbidity in long-term survivors of testicular cancer: a 20-year follow-up study. J Clin Oncol. 2010;28:4649–57. CrossRef
- Howlander N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, et al. SEER cancer statistics review, 1975–2008. Bethesda: National Cancer Institute; 2011.
- Enright K, Krzyzanowska M. Control of cardiovascular risk factors among adult cancer survivors: a population-based survey. Cancer Causes Control. 2010;21:1867–74. CrossRef
- Bambs C, Kip KE, Dinga A, Mulukutla SR, Aiyer AN, Reis SE. Low prevalence of “ideal cardiovascular health” in a community-based population: the heart strategies concentrating on risk evaluation (Heart SCORE) study. Circulation. 2011;123:850–7. CrossRef
- Shay CM, Ning H, Allen NB, Carnethon MR, Chiuve SE, Greenlund KJ, et al. Status of cardiovascular health in US adults: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2003–2008. Circulation. 2012;125:45–56. CrossRef
- Folsom AR, Yatsuya H, Nettleton JA, Lutsey PL, Cushman M, Rosamond WD. Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol. 2011;57:1690–6. CrossRef
- Sabatino SA, Coates RJ, Uhler RJ, Pollack LA, Alley LG, Zauderer LJ. Provider counseling about health behaviors among cancer survivors in the United States. J Clin Oncol. 2007;25:2100–6. CrossRef
- Haggstrom DA, Arora NK, Helft P, Clayman ML, Oakley-Girvan I. Follow-up care delivery among colorectal cancer survivors most often seen by primary and subspecialty care physicians. J Gen Intern Med. 2009;24 Suppl 2:S472–9. CrossRef
- Bellizzi KM, Aziz NM, Rowland JH, Weaver K, Arora NK, Hamilton AS, et al. Double jeopardy? Age, race, and HRQOL in older adults with cancer. J Cancer Epidemiology. 2012;2012:1–9. CrossRef
- Kent EE, Arora NK, Rowland JH, Bellizzi KM, Forsythe LP, Hamilton AS, et al. Health information needs and health-related quality of life in a diverse population of long-term cancer survivors. Patient Educ Couns. 2012;89:345–52.
- Haskell WL, Lee I-M, Pate RP, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1081–93. CrossRef
- Bellizzi KM, Rowland JH, Arora NK, Hamilton AS, Miller MF, Aziz NM. Physical activity and quality of life in adult survivors of non-Hodgkin’s lymphoma. J Clin Oncol. 2009;27:960–6. CrossRef
- California Health Interview Survey. CHIS 2005 adult public use file. Los Angeles: UCLA Center for Health Policy Research; 2011.
- California Health Interview Survey. CHIS 2005 methodology series: report 4—response rates. 2007. Los Angeles: UCLA Center for Health Policy Research. Available at: http://healthpolicy.ucla.edu/chis/design/Documents/CHIS2005_method4.pdf
- UCLA Center for Health Policy Research. California Health Interview Survey. Available at www.askchis.com
- Ma J, Urizar Jr GG, Alehegn T, Stafford RS. Diet and physical activity counseling during ambulatory care visits in the United States. Prev Med. 2004;39:815–22. CrossRef
- Huffman MD, Capewell S, Ning H, Shay CM, Ford ES, Lloyd-Jones DM. Cardiovascular health behavior and health factor changes (1988–2008) and projections to 2020: results from the National Health and Nutrition Examination Surveys. Circulation. 2012;125:2595–602. CrossRef
- Baker F, Denniston M, Smith T, West MM. Adult cancer survivors: how are they faring? Cancer. 2005;104:2565–76. CrossRef
- Pakilit AT, Kahn BA, Petersen L, Abraham LS, Greendale GA, Ganz PA. Making effective use of tumor registries for cancer survivorship research. Cancer. 2001;92:1305–14. CrossRef
- Landy DC, Miller TL, Lopez-Mitnik G, Lipsitz SR, Hinkle AS, Constine LS, et al. Aggregating traditional cardiovascular disease risk factors to assess the cardiometabolic health of childhood cancer survivors: an analysis from the Cardiac Risk Factors in Childhood Cancer Survivors Study. Am Heart J. 2012;163:295–301. CrossRef
- Centers for Disease Control and Prevention. Missed opportunities in preventive counseling for cardiovascular disease—United States, 1995. JAMA. 1998;279:741–2. CrossRef
- Hong S, Nekhlyudov L, Didwania A, Olopade O, Ganschow P. Cancer survivorship care: exploring the role of the general internist. J Gen Intern Med. 2009;24:495–500. CrossRef
- Klabunde CN, Ambs A, Keating NL, He Y, Doucette WR, Tisnado D, et al. The role of primary care physicians in cancer care. J Gen Intern Med. 2009;24:1029–36. CrossRef
- Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr. 2010;2010:25–30. CrossRef
- Snyder C, Frick K, Peairs K, Kantsiper M, Herbert R, Blackford A, et al. Comparing care for breast cancer survivors to non-cancer controls: a five-year longitudinal study. J Gen Intern Med. 2009;24:469–74. CrossRef
- Snyder C, Earle C, Herbert R, Neville B, Blackford A, Frick K. Trends in follow-up and preventive care for colorectal cancer survivors. J Gen Intern Med. 2008;23:254–9. CrossRef
- Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH. Cancer survivors: a booming population. Cancer Epidemiol Biomarkers Prev. 2011;20:1996–2005. CrossRef
- Lenihan DJ, Cardinale D, Cipolla CM. The compelling need for a cardiology and oncology partnership and the birth of the International CardiOncology Society. Prog Cardiovasc Dis. 2010;53:88–93. CrossRef
- Lindenfeld J, Kelly PA. Developing a cardiology–oncology clinical practice guideline. Prog Cardiovasc Dis. 2010;53:173–9. CrossRef
- Mann DL, Krone RJ. Cardiac disease in cancer patients: an overview. Prog Cardiovasc Dis. 2010;53:80–7. CrossRef
- Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care?
Journal of Cancer Survivorship
Volume 7, Issue 2 , pp 253-261
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Cancer survivorship
- Cardiovascular diseases
- Risk factors
- Health behaviors
- Industry Sectors
- Author Affiliations
- 1. Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- 2. Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
- 3. Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- 4. Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
- 5. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- 6. Cancer Prevention Institute of California, Fremont, CA, USA
- 7. Information Management Services, Silver Spring, MD, USA
- 8. National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA