Cardiovascular disease incidence in adolescent and young adult cancer survivors: a retrospective cohort study

Theresa H Keegan, Lawrence H. Kushi, Qian Li, Ann Brunson, X. Chawla, Helen K Chew, Marcio Malogolowkin, Theodore Wun

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalJournal of Cancer Survivorship
DOIs
StateAccepted/In press - Feb 9 2018

Fingerprint

Survivors
Young Adult
Cohort Studies
Cardiovascular Diseases
Retrospective Studies
Incidence
Neoplasms
Confidence Intervals
Cancer Care Facilities
State Hospitals
Health Insurance
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Social Class
African Americans
Non-Hodgkin's Lymphoma
Registries
Coronary Artery Disease
Central Nervous System
Heart Failure

Keywords

  • Adolescent
  • Cancer
  • Cardiovascular diseases
  • Insurance
  • Race/ethnicity
  • Socioeconomic factors
  • Young adult

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)

Cite this

@article{cb7754237d464ff1a032907a3c47d7f1,
title = "Cardiovascular disease incidence in adolescent and young adult cancer survivors: a retrospective cohort study",
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.",
keywords = "Adolescent, Cancer, Cardiovascular diseases, Insurance, Race/ethnicity, Socioeconomic factors, Young adult",
author = "Keegan, {Theresa H} and Kushi, {Lawrence H.} and Qian Li and Ann Brunson and X. Chawla and Chew, {Helen K} and Marcio Malogolowkin and Theodore Wun",
year = "2018",
month = "2",
day = "9",
doi = "10.1007/s11764-018-0678-8",
language = "English (US)",
pages = "1--10",
journal = "Journal of Cancer Survivorship",
issn = "1932-2259",
publisher = "Springer New York",

}

TY - JOUR

T1 - Cardiovascular disease incidence in adolescent and young adult cancer survivors

T2 - a retrospective cohort study

AU - Keegan, Theresa H

AU - Kushi, Lawrence H.

AU - Li, Qian

AU - Brunson, Ann

AU - Chawla, X.

AU - Chew, Helen K

AU - Malogolowkin, Marcio

AU - Wun, Theodore

PY - 2018/2/9

Y1 - 2018/2/9

N2 - 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.

AB - 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.

KW - Adolescent

KW - Cancer

KW - Cardiovascular diseases

KW - Insurance

KW - Race/ethnicity

KW - Socioeconomic factors

KW - Young adult

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U2 - 10.1007/s11764-018-0678-8

DO - 10.1007/s11764-018-0678-8

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JO - Journal of Cancer Survivorship

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SN - 1932-2259

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