Childhood cancer survivors undertreated for CVD risk factors vs. controls
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Adult survivors of childhood cancer were more likely be undertreated for CVD risk factors, particularly hypertension and dyslipidemia, compared with controls, according to data published in the Journal of the American Heart Association.
“These findings make underdiagnosis and undertreatment significant concerns for the estimated half a million childhood cancer survivors living in the United States,” Eric J. Chow, MD, MPH, associate professor in clinical research and public health sciences at the Fred Hutchinson Cancer Center in Seattle, said in a press release.
Adult American survivors of childhood cancer who were free of ischemic heart disease or HF and living within 50 miles of nine major metropolitan areas were enrolled in the Childhood Cancer Survivor Study (CCSS), a randomized clinical trial evaluating a telehealth-based survivorship care plan that could improve CV outcomes.
For the present analysis, 571 participants from CCCS (median age, 38 years; 57% women; 85% white) were compared with a matched sample of individuals from the National Health and Nutrition Examination Survey, and multivariable logistic regression models were used to assess the odds of CVD risk factor underdiagnosis and undertreatment among survivors of childhood cancer compared with the matched sample.
All patients in the CCSS cohort were deemed high risk for ischemic heart disease, were diagnosed with cancer before age 21 years and had prior exposures to anthracyclines and chest radiation. Participants completed in-home clinical assessments and telehealth-delivered questionnaires assessing medical history, CV health, medication adherence and other lifestyle risk factors.
The average length of time from initial childhood cancer diagnosis to trial enrollment was 28.5 years.
Survivors of childhood cancer were more likely to have prior CVD risk factors, such as hypertension (18% vs. 11%), dyslipidemia (14% vs. 4.9%) and diabetes (6.5% vs. 3.2%; P for all < .05) compared with controls.
Researchers reported that, although rate of underdiagnosis of CVD risk factors was similar between survivors of childhood cancer and the controls (27.1% vs. 26.1%; P = .73), survivors were more likely to be undertreated (21% vs. 13.9%; OR = 1.8; 95% CI, 1.2-2.7; P = .007).
Even after adjusting for BMI and smoking status, survivors of childhood cancer remained at elevated odds for risk factor undertreatment (OR = 2; 95% CI, 1.3-3.1).
Moreover, the most underdiagnosed and undertreated CVD risk factors among survivors of childhood cancer were hypertension (18.9%) and dyslipidemia (16.3%); however, the mean predicted 30-year risk for a CVD event was lower among cancer survivors compared with the controls.
Researchers determined that characteristics associated with CVD risk factor underdiagnosis and undertreatment in cancer survivors included male sex, increased BMI, presence of at least two lifestyle risk factors, older age and prior chest radiation exposure.
“Serious heart disease is uncommon in young adults in the general population, which includes childhood cancer survivors, therefore, greater awareness of the significantly higher cardiovascular disease risk when there is a history of cancer is important,” Chow said in the release. “Raising awareness among primary care professionals as well as improving survivors’ ability to self-manage their health may mitigate the increased risks. There are specialized heart disease risk calculators designed for cancer survivors, and those may be more accurate in predicting future cardiovascular disease risk than risk calculators designed for the general population.”
Reference:
- Adult survivors of childhood cancer often undertreated for cardiovascular risk factors. newsroom.heart.org/news/adult-survivors-of-childhood-cancer-often-undertreated-for-cardiovascular-risk-factors. Published June 8, 2022. Accessed June 8, 2022.
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