People who survive childhood cancers have a greater risk of heart disease and other health conditions later in life, according to a study published in the February 2023 issue of Cancer. “Without access to preventive healthcare or healthy lifestyle choices, many [survivors] will develop chronic conditions,” says Amy Berkman, MD, a medical resident in Duke University's Department of Pediatrics and the lead author of the study.
Research published in the Journal of the American Heart Association in June 2022 found that heart risk among childhood cancer survivors is often underdiagnosed and undertreated. Dr. Berkman’s study offers findings that can arm providers with key insights they need to better treat patients who survived cancer in their youth.
The newer study showed which social determinants of health and risk factors associated with heart disease most impact survivor heart health outcomes. The U.S. Department of Health and Human Services defines social determinants of health as the conditions in which people are born, live, learn, work, and age that affect their health, including things like race, gender, and socioeconomic status.
The researchers assessed information from 4,766 cancer survivors and 47,660 controls (people without a history of cancer) collected between 2009 and 2018. “We found that certain social determinants of health were associated with increased odds of heart disease in adolescent and young adult cancer survivors,” Berkman says, “as were traditional heart disease risk factors, including smoking and lack of physical activity.”
Addressing Heart Health Outcomes in Certain Populations
The Cancer study found that a household income of less than $50,000 a year increased the chances of heart disease in survivors, as did being male and Black. Compared with white survivors, survivors who were Black were more than twice as likely to have heart disease.
Berkman thinks these findings highlight the need for providers to tailor their heart health screening approaches to patients with social determinants of health that put them at an increased risk of heart disease. “[We need] to focus on prevention of cardiovascular disease through access to follow-up care and education around healthy lifestyle choices, especially in minoritized and lower-income populations of survivors,” she says.
Lowering Your Heart Disease Risk
The study also helped clarify which risk factors most affect heart health outcomes for survivors of adolescent and young adult cancers. Risk factors are habits or health conditions that can increase your risk of heart disease that you can manage or change to lower your risk. Smoking cessation, medication to lower your blood pressure and cholesterol levels, healthy eating, and exercise are just a few things you can do to lower your risk, according to the American Heart Association.
Indeed, study participants who did regular moderate to vigorous physical activity had lower heart disease odds. Meanwhile, being overweight or obese and smoking more often were associated with a higher likelihood of heart disease in both survivor and control groups. The findings indicate that childhood cancer survivors and their care teams should focus on not smoking, maintaining a healthy weight, and increasing their physical activity to 150 minutes per week to lower risk.
Heart disease risk can change, though, depending on what kind of treatment a cancer patient gets. “This information is not included in the database,” says Berkman. “We were also unable to assess the timing of cardiovascular disease diagnosis, so it is not known whether minoritized survivors are also at risk of developing cardiovascular disease earlier in the survivorship period than non-minoritized survivors.”
But according to Kathryn Ruble, PhD, the director of the Life Clinic and Leukemia Survivorship program and an associate professor of oncology at Johns Hopkins University in Baltimore, who was not involved in the study, enough research has already been done on different treatment exposures. “We know a lot about that already,” Dr. Ruble says. “Now I think we need to start looking at interventions. And this paper sets us up nicely to identify where we can start with those interventions.”
More Research Is Needed
According to Berkman, while other studies have focused on disparities in short-term health outcomes for adolescent and young adult cancer patients, this study’s findings show that disparities in health outcomes exist well into survivorship. “Cancer cure is not enough,” she says. “Long-term health and quality of life are important, and there needs to be better awareness of long-term health outcomes and initiation of early screening and prevention.”
Berkman says a better understanding of health behavior changes that occur during and after cancer treatment in survivors could help researchers identify heart healthcare and treatment opportunities. Her team is working on research to better understand the extent to which a cancer diagnosis worsens preexisting health disparities within a marginalized population.
But more research should focus on social determinants of health, notes Ruble. “None of our [treatment] guidelines now take [social determinants of health] into account,” she says. Ruble also thinks research analyzing how social determinants of health influence the way providers treat patients can help clarify how best to help a specific patient.
Ruble calls this study a “good news paper.” “It gives us something to claw onto and say, ‘The good news is some of these things associated [with your heart disease risk] are modifiable. I can’t go back and take away your radiation, but here is some evidence that there are things we can do to improve outcomes,’” she says.