Age at diagnosis and cancer subtype may affect risk for CV death among cancer survivors
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Among survivors of nine common cancers, risk for CV death overtook cancer mortality for most cancer subtypes among patients aged at least 80 years, researchers reported.
According to data published in JACC: CardioOncology, the time point from cancer diagnosis that risk for CV death overtook risk for cancer death varied by age at diagnosis and cancer subtype.
“With improvements in cancer detection and care, people are living longer after cancer. Adult survivors of most cancer sites are at higher risk for cardiovascular disease compared with the general population, with variation in the size and duration of risk among cancer sites and age groups,” Helen Strongman, PhD, epidemiologist at the London School of Hygiene & Tropical Medicine, and colleagues wrote. “We therefore aimed to identify whether, and at what time point, risk for cardiovascular mortality overtakes risk for mortality from the primary cancer and all cancers combined, by age, in survivors of the nine most common cancers in England.”
For the present analysis, researchers identified 104,028 patients with one of nine of the most common cancers in the U.K. who were alive with follow-up at least 1 year after cancer diagnosis (mean age, 68 years; 51% women): colorectal cancer, lung cancer, malignant melanoma, breast cancer, uterine cancer, prostate cancer, bladder cancer, non-Hodgkin lymphoma and leukemia.
Patients were stratified and assessed by age group: 40 to 59 years, 60 to 79 years and 80 years or older.
Age-stratified CV vs. cancer mortality
Researchers observed that risk for CV death overtook death from cancer at 2 to 11 years after cancer diagnosis among survivors of all nine types of cancer aged 80 years or older at diagnosis.
At 5.9 to 17.1 years after cancer diagnosis, CV death overtook death from cancer among survivors of all except uterine cancer, colorectal cancer and malignant melanoma aged 80 years or older at diagnosis.
Risk for CV death overtook death from cancer at 5 to 17 years after cancer diagnosis among survivors of all except prostate cancer and leukemia aged 60 to 79 years at diagnosis.
Risk for CV death overtook death from cancer among survivors of uterine cancer at 17.5 years and malignant melanoma at 19.6 years among those aged 60 to 79 years at diagnosis.
Among patients aged 40 to 59 years at cancer diagnosis, risk for CV death remained low and only overtook death from cancer among survivors of uterine cancer after 11 years, according to the study.
Posttreatment CV monitoring ‘must be a priority’
“The large sample size is a strength of the study; however ... comparisons were not made with a population without cancer or CVD, matched for age, sex, race, comorbidities and other factors in order to determine norms in the age groups,” Linda A. Jacobs, PhD, CRNP, nurse practitioner and founding director of the Cancer Survivorship Center of Excellence at Penn Medicine, wrote in a related editorial. “The lack of cancer characteristics and treatment data is a significant limitation as well.
“However, Strongman et al are to be commended for the large analyses they undertook,” Jacobs wrote. “The importance of post-cancer monitoring with care focused on risk for cancer relapse is crucial. Posttreatment cardiovascular monitoring and follow-up care as well as lifelong monitoring for all late effects of the treatment received must be a priority in cancer care as well.”
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