1. DiGiulio, Sarah

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Advances in cancer research, treatments, and care have simultaneously improved five-year survival rates and created a population of patients with health surveillance and screening needs drastically different than their peers, coauthors Malek J. Baassiri, MD, a fellow in Cancer Survivorship at St. Jude Children's Research Hospital, and Daniel A. Mulrooney, MD, MS, of St. Jude, explain in a recent editorial in the Journal of Clinical Oncology (2016;34:1570-1572).

Daniel A. Mulrooney.... - Click to enlarge in new windowDaniel A. Mulrooney. Daniel A. Mulrooney, MD, MS

They are referring to cancer survivors who not only because of the biology of their tumors, but also because of side- and late-effects of their cancer treatment and radiation have different health care needs than others without cancer. And in this editorial, Baassiri and Mulrooney more specifically address the needs of survivors of childhood cancers, whose survivorship period can be a lifetime, and even more specifically how their risks of cardiovascular disease differ from their peers without a history of cancer.


The editorial is a response to a study by Chao, et al, that analyzed the medical records of 5,673 adolescents and young adults with a history of cancer (diagnosed between ages 15 and 39), matching them with 57,617 patients with no history of cancer as a control group (JCO 2016;34:1626-1633). The data showed the rate of cardiovascular disease in cancer survivors was 2.37 times the rate in the healthy population.


This finding has big implications for an entire population of cancer survivors across their lifetimes, Baassiri and Mulrooney explain. The editorial states: "Screening and treatment of these risk factors, well known to modify health outcomes in adults, may be overlooked in a younger population yet potentially be of even greater importance for those exposed to cancer therapies."


In an email interview, Mulrooney, Assistant Member of the St. Jude Faculty, elaborated on the implications of these findings and why there is still a lot to understand about cancer survivorship.


1 What is new about these findings from Chao, et al, compared with other survivorship research?

"Investigators were able to use a series of large, comprehensive datasets to describe the risk of and mortality from cardiovascular disease in a young population of cancer survivors (the mean age was 33.4 years). Other studies frequently only include adolescent and young adult cancer survivors as a subset of the broader study population. [Chao and his colleagues] were able to focus their study uniquely on this population.


"Not only did the investigators identify an increased risk for cardiovascular disease, but [they] also described the added risk of other known cardiovascular risk factors (among survivors with diabetes CVD rates were 3.18 times higher; among survivors with hypertension CVD rates were 3.67 times higher; and among survivors with dyslipidemia CVD rates were 1.79 times higher).


"These [risks] are important for primary care providers caring for this population to be aware of because these are modifiable risk factors that can be treated with lifestyle modifications and/or medication."


2 The editorial mentions it is noteworthy that the patients in this study all came from a single insurance database. How does that inform the implications of these findings from Chao, et al?

"The study used individuals in the Kaiser Permanente Southern California Health Plan databases, thus individuals who were insured and received care through this organization. Cancer survivors who are not insured, or who may have had difficulty obtaining insurance, are not included.


"Therefore, the findings of the study may actually underestimate the incidence and risks of cardiovascular disease in this population."


3 What should all practicing oncologists and cancer care providers know about these findings?

"The importance of screening for and treating modifiable cardiovascular risk factors in survivors of adolescent and young adult cancers.


"Future studies need to investigate if the risk of cardiovascular disease can be reduced by early identification and treatment of associated risk factors."