Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care?
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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.
KeywordsCancer 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
- 9.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.Google Scholar
- 17.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.Google Scholar
- 20.California Health Interview Survey. CHIS 2005 adult public use file. Los Angeles: UCLA Center for Health Policy Research; 2011.Google Scholar
- 21.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
- 22.UCLA Center for Health Policy Research. California Health Interview Survey. Available at www.askchis.com
- 27.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.PubMedCrossRefGoogle Scholar