1. Conick, Hal

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In the fight against cancer, recent research shows that patients and physicians should also be fighting hard against cardiovascular disease. A study published in the European Heart Journal, titled "A population-based study of cardiovascular disease mortality risk in US cancer patients," found that more than one in 10 cancer patients die from cardiovascular disease rather than cancer (2019;40(48):3889-3897).


The analysis-a large, comprehensive study that compared 3.2 million U.S. cancer patients with the general population over the past 40 years-found that the chance of dying from cardiovascular disease increased for patients with more treatable cancers. About half of people with breast, prostate, endometrial, and thyroid cancer died of cardiovascular disease.


Of cancer patients who died from cardiovascular disease:


* 19 percent had bladder cancer;


* 17 percent had larynx cancer;


* 17 percent had prostate cancer;


* 16 percent had womb cancer;


* 14 percent had bowel cancer; and


* 12 percent had breast cancer.



From the 3.2 million sample of patients, 38 percent died from cancer and 11 percent died from cardiovascular disease. Among those who died of cardiovascular disease, 76 percent died because of heart disease. Patients who are younger than 35 have a higher chance of dying from cardiovascular disease, as do patients in the first year after their cancer diagnosis.


Kathleen Sturgeon, PhD, MTR, Assistant Professor in Public Health Sciences at the Penn State Cancer Institute, said the connection between cancer and cardiovascular disease has been made before, but she hopes that this broad overview of how cancer is linked to cardiovascular death can help physicians treat patients.


"If you have a cancer survivor-independent of what type-walking in your door, you know that they're going to be at elevated risk for cardiovascular death," Sturgeon said. "The goal is to take a step back and do a broad examination so that we could provide that information to a more general physician population."


Sturgeon has recently seen just how much medical health records lack information that could be critical to patient survival. In January, her father died after a years-long battle with cancer and COPD, even though he had never been a smoker. When Sturgeon looked at her father's medical records, she didn't see the notation that her father was a cancer survivor, no note signifying that doctors need to be more aggressive with their treatment to fight against risk factors for cardiovascular disease.


"It just wasn't present," she said. "I think physicians who are specialists in other areas, they sometimes just treat what they know instead of taking a step back and looking at the whole patient. And for cancer survivors, [taking this step] is very important."


Sturgeon hopes for improvement. One of the first things she and her coauthors did for this research was look at historical data, and the gigantic drop in cancer rate from 1974 has been radical. That there's also been a rise of cardiovascular disease in cancer survivors in that time is vexing, but she believes that teaching physicians about the high rate of cardiovascular disease could help them focus on more aggressive treatment. And the problem won't go away on its own. As Nicholas Zaorsky, MD, Assistant Professor in the Department of Public Health Sciences at the Penn State Cancer Institute and one of the study's co-authors noted: "As the number of cancer survivors increase, the rate of cardiovascular deaths will continue to rise."


Physicians can use this knowledge to help cancer patients fight the risk of cardiovascular disease. This may mean putting patients on medication for high blood pressure, it could mean encouraging the patient to eat and sleep better, and it could mean telling the patient to visit a trained exercise physiologist. Clinicians aren't always equipped to set patients up in an exercise program, Sturgeon says, but they can encourage patients to exercise.


"If you're looking to cut down on cardiovascular deaths, that's a chronic disease on top of cancer, which is also a chronic disease," she noted. "You have to have chronic behaviors [such as exercise, sleep, and healthy food] to counteract these chronic diseases."


With the rise of electronic medical records, Sturgeon hopes that physicians and health systems can do a better job of giving patients survivorship care plans, empowering patients to be aware of health issues they may encounter. Patients are the best advocates for their own health, she said, and they should be made fully aware of what health issues they may encounter.


"We can provide that information. Maybe they can be more aware for themselves and work hand-in-hand with other physicians. Maybe they have some mobility through different health care systems where [physicians] may not be aware of how to treat them," Sturgeon stated. "At the patient level, we can do better."


Hal Conick is a contributing writer.