Survived cancer? Now look out for cardiovascular risks

(Press-News.org) WINSTON-SALEM, N.C., – April 16, 2013 – Many people survive their cancers, but end up dying of cardiovascular disease (CVD). New research from Wake Forest Baptist Medical Center finds that CVD risk factors may be overlooked during survivorship care.

Kathryn E. Weaver, Ph.D., assistant professor of social sciences and health policy at Wake Forest Baptist, and colleagues surveyed survivors of breast, prostate, colorectal and gynecologic cancers in search of answers.

"Increasingly, we are concerned about cardiovascular health in long-term cancer survivors, and we believe this is a high-risk group that needs close attention," lead author Weaver said. "As part of good survivorship health, it's going to be increasingly important for health care providers to assess and address cardiovascular risk in cancer survivors."

For example, Weaver said there is data showing that early stage breast cancer patients are more likely to die of CVD than of breast cancer. There are many reasons why cancer survivors have higher CVD risks, she said, most typically because cancer shares many of the same risk factors such as smoking, low physical activity and obesity. Also, some of the treatments cancer patients undergo may put them at higher risk, she said.

The survey participants were recruited from two cancer registries. A total of 1,582 survivors who were four to 14 years beyond diagnosis were asked in a mail survey to assess CVD risk factors, including smoking, body mass index, physical inactivity, hypertension and diabetes. The researchers also asked the participants whether they had engaged in discussions with health care providers about making lifestyle changes through diet, exercise and quitting smoking.

With the exception of current smoking, CVD risk factors were more common among survivors than the general adult population. Of survivors, 62 percent were overweight or obese, 55 percent reported hypertension, 20.7 percent reported diabetes, 18.1 percent were inactive, and 5.1 percent were current smokers. Nearly a third of survivors with CVD risk factors did not report health-promotion discussions with their medical teams.

Weaver said they also saw significant differences for Hispanic and African-American survivors when compared to white survivors that are similar to those observed in adults without cancer. These two ethnic groups had a greater number of CVD risk factors, particularly obesity and diabetes.

"What we found is that cancer survivors do have more cardiovascular risk factors than the general adult population, and they often do not report talking with their health care provider about ways to reduce their risk through lifestyle changes like exercising and losing weight," Weaver said.

This study highlights the need for more awareness by cancer survivors and their doctors, Weaver said. "Our message is that cardiovascular disease risk should be assessed as part of a comprehensive survivorship care plan because of the risk for both poor heart disease and cancer outcomes," she said. "Cancer providers don't have to be solely responsible for talking to survivors about lifestyle factors, but, if it's noted as part of the wellness goals for that survivor, then risk factors are more likely to be addressed by the survivors' treatment team, including primary care."

### The findings are published online ahead of print this month in the Journal of Cancer Survivorship. The research was supported by the National Cancer Institute at the National Institutes of Health, N01-PC- 479 35136 and HHSN 261201100189P.

Co-authors include: Randi E. Foraker, M.A., Ph.D., The Ohio State University College of Public Health; Catherine M. Alfano, Ph.D., Julia H. Rowland, Ph.D., Neeraj K. Arora, Ph.D., and Noreen M. Aziz, M.D., Ph.D., M.P.H., all of NIH; Keith M. Bellizzi, Ph.D., M.P.H., University of Connecticut; Ann S. Hamilton, Ph.D., M.A., University of Southern California; Ingrid Oakley-Girvan, Ph.D., M.P.H., Cancer Prevention Institute of California; and Gretchen Keel, Information Management Services.