Journal of Cancer Survivorship

, Volume 7, Issue 2, pp 253–261 | Cite as

Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care?

  • Kathryn E. Weaver
  • Randi E. Foraker
  • Catherine M. Alfano
  • Julia H. Rowland
  • Neeraj K. Arora
  • Keith M. Bellizzi
  • Ann S. Hamilton
  • Ingrid Oakley-Girvan
  • Gretchen Keel
  • Noreen M. Aziz



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.


Cancer survivorship Cardiovascular diseases Risk factors Health behaviors Epidemiology Cancer 



This work was supported by the National Cancer Institute at the National Institutes of Health. Contracts No. N01-PC-35136 and HHSN 261201100189P. The ideas and opinions expressed herein are those of the authors and endorsement by the NCI, and/or their contractors and subcontractors is not intended nor should be inferred.

Conflict of interest


Supplementary material

11764_2013_267_MOESM1_ESM.docx (43 kb)
ESM 1 (DOCX 43 kb)


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Copyright information

© Springer Science+Business Media New York (outside the USA)  2013

Authors and Affiliations

  • Kathryn E. Weaver
    • 1
  • Randi E. Foraker
    • 2
  • Catherine M. Alfano
    • 3
  • Julia H. Rowland
    • 3
  • Neeraj K. Arora
    • 3
  • Keith M. Bellizzi
    • 4
  • Ann S. Hamilton
    • 5
  • Ingrid Oakley-Girvan
    • 6
  • Gretchen Keel
    • 7
  • Noreen M. Aziz
    • 8
  1. 1.Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston-SalemUSA
  2. 2.Division of EpidemiologyThe Ohio State University College of Public HealthColumbusUSA
  3. 3.Division of Cancer Control and Population Sciences, National Cancer InstituteNational Institutes of HealthBethesdaUSA
  4. 4.Department of Human Development and Family StudiesUniversity of ConnecticutStorrsUSA
  5. 5.Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  6. 6.Cancer Prevention Institute of CaliforniaFremontUSA
  7. 7.Information Management ServicesSilver SpringUSA
  8. 8.National Institute of Nursing ResearchNational Institutes of HealthBethesdaUSA

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