Adolescent and young adult cancer survivors who are African American, poor or have public or no health insurance are far more likely to suffer from coronary artery disease, heart failure or stroke later in life than non-Hispanic white cancer survivors.
In the first of its kind population-based study, UC Davis researcher Theresa Keegan found striking disparities in the risk of cardiovascular disease in cancer survivors depending on racial/ethnic and socio-economic factors. The study was published today in the Journal of Cancer Survivorship.
“Cardiovascular disease is a serious late effect of cancer treatment,” said Keegan, associate professor in the UC Davis Division of Hematology and Oncology. “We observed that the growing population of adolescent and young adult cancer survivors faces considerable morbidity and mortality resulting from cardiovascular disease.”
Cardiovascular disease is a common health problem for young survivors of cancer, with risks varying depending on the intensity and types of treatment received, their age at diagnosis, type of cancer and other factors. Developing cardiovascular disease has been associated with a more than 11-fold higher overall mortality in this group. But until now, no studies had been done to determine if cardiovascular disease risk also differs in these survivors depending on socio-economic factors.
Using data from the California Cancer Registry, the authors analyzed 79,176 patients ages 15-39 diagnosed between 1996 and 2012. The patients had been diagnosed with one of 14 common cancers including leukemia, lymphoma, brain and sarcoma, and had survived two or more years after their initial diagnoses. Researchers linked the cancer registry data to statewide hospitalization data to determine the incidence of cardiovascular disease.
“Numerous studies in the adolescent and young adult population have determined that a patient’s socio-economic status plays an important role in survival,” Keegan said. “We wanted to understand if the disparities are associated with a specific late effect of cancer treatment – cardiovascular disease.”
After controlling for other variables, Keegan and her colleagues found that adolescent and young adult African Americans had a 55 percent higher risk of cardiovascular disease than non-Hispanic whites. People with no insurance or public health insurance had a 78 percent higher risk of cardiovascular disease, and those living in low socio-economic status neighborhoods experienced as much a 66 percent higher risk.
Why these groups have higher risk for cardiovascular disease is not entirely clear; access to care could play a role, and research has shown an association between lifestyle factors such as lower physical activity levels and higher body mass index among African American cancer survivors. Keegan and her colleagues did not have access to behavioral or lifestyle data for patients in the study.
“This study identifies high-risk populations to target for lifestyle interventions and early identification and treatment of cardiovascular disease risk factors, including diabetes, hypertension and dyslipidemia,” Keegan said. “Even though knowledge of high-risk populations can guide follow-up care, it is also critical to address barriers to obtaining follow-up care and adhering to healthy lifestyle behaviors to reduce the impact of cardiovascular disease in these cancer survivors.”
Keegan said additional studies are under way to look at other late effects that adolescent and young adult cancer survivors may face after treatment including second cancers, respiratory problems, renal failure and liver disease.
Study co-authors included Helen Chew, Marcio Malogolowkin, Ann Brunson, Qiann Li and Ted Wun of UC Davis, Lawrence Kushi of Kaiser Permanente Northern California and Neetu Chawla of Kaiser Permanente Northern California and VA HSR&D Center for the Study of Healthcare Innovation, Innovation and Policy in Los Angeles.
The study was supported by the Rich and Weissman Family Lymphoma and Survivorship Fund, St. Baldrick’s Research Grant and the National Center for Advancing Translational Sciences (TR000002).