Theresa H M Keegan1,2, Lawrence H Kushi3, Qian Li4, Ann Brunson4, X Chawla3,5, Helen K Chew4, Marcio Malogolowkin6, Ted Wun4. 1. Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA. tkeegan@ucdavis.edu. 2. Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA. tkeegan@ucdavis.edu. 3. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. 4. Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA. 5. VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. 6. Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA.
Abstract
PURPOSE: Few population-based studies have focused on cardiovascular disease (CVD) risk in adolescent and young adult (AYA; 15-39 years) cancer survivors and none have considered whether CVD risk differs by sociodemographic factors. METHODS: Analyses focused on 79,176 AYA patients diagnosed with 14 first primary cancers in 1996-2012 and surviving > 2 years after diagnosis with follow-up through 2014. Data were obtained from the California Cancer Registry and State hospital discharge data. CVD included coronary artery disease, heart failure, and stroke. The cumulative incidence of developing CVD accounted for the competing risk of death. Multivariable Cox proportional hazards regression evaluated factors associated with CVD and the impact of CVD on mortality. RESULTS: Overall, 2249 (2.8%) patients developed CVD. Survivors of central nervous system cancer (7.3%), acute lymphoid leukemia (6.9%), acute myeloid leukemia (6.8%), and non-Hodgkin lymphoma (4.1%) had the highest 10-year CVD incidence. In multivariable models, African-Americans (hazard ratio (HR) = 1.55, 95% confidence interval (CI) = 1.33-1.81; versus non-Hispanic Whites), those with public/no health insurance (HR = 1.78, 95% CI = 1.61-1.96; versus private) and those who resided in lower socioeconomic status neighborhoods had a higher CVD risk. These sociodemographic differences in CVD incidence were apparent across most cancer sites. The risk of death was increased by eightfold or higher among AYAs who developed CVD. CONCLUSION: While cancer therapies are known to increase the risk of CVD, this study additionally shows that CVD risk varies by sociodemographic factors. IMPLICATIONS FOR CANCER SURVIVORS: The identification and mitigation of CVD risk factors in these subgroups may improve long-term patient outcomes.
PURPOSE: Few population-based studies have focused on cardiovascular disease (CVD) risk in adolescent and young adult (AYA; 15-39 years) cancer survivors and none have considered whether CVD risk differs by sociodemographic factors. METHODS: Analyses focused on 79,176 AYA patients diagnosed with 14 first primary cancers in 1996-2012 and surviving > 2 years after diagnosis with follow-up through 2014. Data were obtained from the California Cancer Registry and State hospital discharge data. CVD included coronary artery disease, heart failure, and stroke. The cumulative incidence of developing CVD accounted for the competing risk of death. Multivariable Cox proportional hazards regression evaluated factors associated with CVD and the impact of CVD on mortality. RESULTS: Overall, 2249 (2.8%) patients developed CVD. Survivors of central nervous system cancer (7.3%), acute lymphoid leukemia (6.9%), acute myeloid leukemia (6.8%), and non-Hodgkin lymphoma (4.1%) had the highest 10-year CVD incidence. In multivariable models, African-Americans (hazard ratio (HR) = 1.55, 95% confidence interval (CI) = 1.33-1.81; versus non-Hispanic Whites), those with public/no health insurance (HR = 1.78, 95% CI = 1.61-1.96; versus private) and those who resided in lower socioeconomic status neighborhoods had a higher CVD risk. These sociodemographic differences in CVD incidence were apparent across most cancer sites. The risk of death was increased by eightfold or higher among AYAs who developed CVD. CONCLUSION: While cancer therapies are known to increase the risk of CVD, this study additionally shows that CVD risk varies by sociodemographic factors. IMPLICATIONS FOR CANCER SURVIVORS: The identification and mitigation of CVD risk factors in these subgroups may improve long-term patient outcomes.
Authors: Sharyl J Nass; Lynda K Beaupin; Wendy Demark-Wahnefried; Karen Fasciano; Patricia A Ganz; Brandon Hayes-Lattin; Melissa M Hudson; Brenda Nevidjon; Kevin C Oeffinger; Ruth Rechis; Lisa C Richardson; Nita L Seibel; Ashley W Smith Journal: Oncologist Date: 2015-01-07
Authors: Theresa H M Keegan; Li Tao; Mindy C DeRouen; Xiao-Cheng Wu; Pinki Prasad; Charles F Lynch; Margarett Shnorhavorian; Brad J Zebrack; Roland Chu; Linda C Harlan; Ashley W Smith; Helen M Parsons Journal: J Cancer Surviv Date: 2014-01-10 Impact factor: 4.442
Authors: Sanjat Kanjilal; Edward W Gregg; Yiling J Cheng; Ping Zhang; David E Nelson; George Mensah; Gloria L A Beckles Journal: Arch Intern Med Date: 2006-11-27
Authors: Raymond R Russell; Jonathan Alexander; Diwakar Jain; Indu G Poornima; Ajay V Srivastava; Eugene Storozynsky; Ronald G Schwartz Journal: J Nucl Cardiol Date: 2016-06-01 Impact factor: 5.952
Authors: Ayal A Aizer; Benjamin Falit; Mallika L Mendu; Ming-Hui Chen; Toni K Choueiri; Karen E Hoffman; Jim C Hu; Neil E Martin; Quoc-Dien Trinh; Brian M Alexander; Paul L Nguyen Journal: J Clin Oncol Date: 2014-06-02 Impact factor: 44.544
Authors: Helen M Parsons; Susanne Schmidt; Linda C Harlan; Erin E Kent; Charles F Lynch; Ashley W Smith; Theresa H M Keegan Journal: Cancer Date: 2014-06-04 Impact factor: 6.921
Authors: Theresa H M Keegan; David J Press; Li Tao; Mindy C DeRouen; Allison W Kurian; Christina A Clarke; Scarlett L Gomez Journal: Breast Cancer Res Date: 2013 Impact factor: 6.466
Authors: Chelsea Anderson; Jennifer L Lund; Mark A Weaver; William A Wood; Andrew F Olshan; Hazel B Nichols Journal: Cancer Epidemiol Biomarkers Prev Date: 2019-06-17 Impact factor: 4.254
Authors: Amy M Berkman; Clark R Andersen; Vidya Puthenpura; J A Livingston; Sairah Ahmed; Branko Cuglievan; Michelle A T Hildebrandt; Michael E Roth Journal: Cancer Epidemiol Date: 2021-09-28 Impact factor: 2.984
Authors: Daniel A Mulrooney; Yutaka Yasui; Yadav Sapkota; Na Qin; Matthew J Ehrhardt; Zhaoming Wang; Yan Chen; Carmen L Wilson; Jeremie Estepp; Parul Rai; Jane S Hankins; Paul W Burridge; John L Jefferies; Jinghui Zhang; Melissa M Hudson; Leslie L Robison; Gregory T Armstrong Journal: Cancer Res Date: 2020-12-07 Impact factor: 13.312
Authors: Hilary C Tanenbaum; Lanfang Xu; Erin E Hahn; Julie Wolfson; Smita Bhatia; Kim Cannavale; Robert Cooper; Chun Chao Journal: Prev Med Rep Date: 2020-12-01
Authors: Amy M Berkman; Clark R Andersen; Vidya Puthenpura; J Andrew Livingston; Sairah Ahmed; Branko Cuglievan; Michelle A T Hildebrandt; Michael E Roth Journal: Cancer Epidemiol Biomarkers Prev Date: 2021-07-08 Impact factor: 4.254
Authors: Scott C Adams; Jennifer Herman; Iliana C Lega; Laura Mitchell; David Hodgson; Kim Edelstein; Lois B Travis; Catherine M Sabiston; Paaladinesh Thavendiranathan; Abha A Gupta Journal: JNCI Cancer Spectr Date: 2020-10-28