Adults who survive childhood cancer have a significantly higher risk of cardiovascular disease but remain 80% more likely to be undertreated for several cardiovascular risk factors: high blood pressure (hypertension), diabetes and hypercholesterolemia. Previous research has shown that due to their exposure to chemotherapy and/or radiation therapy, childhood cancer survivors face a heightened risk of cardiovascular disease and death but report receiving only medical care. general, not specific to their cancer experience. Moreover, these patients do not benefit from the recommended cardiovascular screenings.
Underdiagnosis and undertreatment of cardiovascular disorders in childhood cancer survivors
Lead author Dr. Eric J. Chow, MD, MPH, associate professor of clinical research and public health sciences at the Fred Hutchinson Cancer Center thus raises the alarm bells, and on a whole range of factors and cardiovascular problems: hypertension, hypercholesterolemia, diabetes, “bad” cholesterol, high levels of triglycerides or even blood sugar above recommendations.
The study is conducted among participants of the Childhood Cancer Survivor Study (CCSS), who were diagnosed with cancer before the age of 21 between 1970 and 1999 and who survived at least 5 years. Between September 2017 and April 2020, the researchers recruited from the cohort childhood cancer survivors who were at least 18 years old, then free of disease and heart failure. Among these participants, the most common types of cancer were leukaemia, lymphoma and bone cancer.
The researchers thus measured blood pressure, lipids, glucose and hemoglobin A1c levels in nearly 600 adults (median age of 37 years) on average 28 years after the diagnosis of cancer and compared these data with those of a control group of 350 adults of the same age with no history of cancer. The analysis reveals,
that cancer survivors are more likely to suffer
- hypertension: 18% vs 11%,
- abnormal lipid levels: 14% vs 4.9%,
- diabetes: 6.5% vs. 3.2%;
- participants in both groups have similar rates of underdiagnosed hypertension, hypercholesterolemia and diabetes: 27.1% in cancer survivors vs. 26.1% in the control group;
- however, cancer survivors are 80% more likely to be undertreated for these conditions vs controls.
“Serious heart disease is rare in young adults in the general population, including childhood cancer survivors, so there is a need to raise awareness of the increased risk of cardiovascular disease in this patient group” comments the author. “Educating primary care professionals and improving the ability of survivors to self-manage their health could better control this risk.”
Other interesting findings:
- the most underdiagnosed and undertreated cardiovascular disease risk factors in cancer survivors are hypertension at 18.9% and lipid disorders at 16.3%;
- among cancer survivors, men are 2 times more likely to be underdiagnosed and undertreated for these cardiovascular factors;
- overweight or obese survivors are 2-3 times more likely to be underdiagnosed and undertreated;
- cancer survivors with 2 or more unhealthy lifestyle factors, such as physical inactivity and low fruit and vegetable intake, are 2 times more likely to be undertreated;
- childhood cancer survivors confident in their ability to manage their own health have a halved risk of undertreatment of cardiovascular disease studied.
In these patients, therapeutic education takes on its full meaning.
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