Adolescent and young adult (AYA) cancer survivors are at increased risk for late- and long-term cardiovascular complications, and providers should urge regular screening and risk-modifying behaviors, researchers said.
That was the conclusion of two literature reviews conducted by Rebecca Hoover, RN, BSN, and Deborah Mayer, PhD, RN, both of the University of North Carolina at Chapel Hill, and presented at the Oncology Nursing Society virtual annual meeting.
“Improvements in cancer treatments have improved cancer survivor rates, yet cancer treatments are associated with late- and long-term effects,” said Hoover during her presentation on AYA cancer survivor treatment-related cardiovascular complications. “Cardiotoxic chemotherapy and chest radiation increases the risk of cardiovascular complications, cardiovascular risk factors, and cardiovascular disease in the population exposed to them.”
This group of patients is particularly at risk, considering that they receive these treatments earlier in life and are likely to receive multiple cardiotoxic treatments throughout their lives, she explained.
For the analysis, Hoover and Mayer conducted a literature review of AYA cancer survivor treatment-related complications, identifying five studies that met the inclusion criteria, all of which were retrospective cohort studies.
An association was evident between cancer treatment and latent cardiovascular effects in survivors, as follows:
- One study indicated an increased standardized mortality ratio (SMR) of 1.55 for AYA cancer survivors, with an SMR of 4.44 for cardiovascular disease within the AYA cancer survivor Hodgkin’s lymphoma population
- Another study found the risk of heart failure in AYA leukemia patients treated with anthracyclines at a dose of more than 300 mg/m2 to be 12 times higher than those treated with a lower dose
- A third study showed AYA cancer patients were more than twice as likely to develop cardiovascular disease compared with patients without cancer, with the highest risk in the AYA population among leukemia and breast cancer survivors
- A fourth study showed that AYA cancer survivors who develop cardiovascular disease have an eight times or higher risk of dying compared with AYA cancer survivors without cardiovascular disease
Additionally, the authors found a positive association between increased dosing of cardiotoxic chemotherapy and/or increased cardiovascular risk factors with the potential for increased cardiovascular-related morbidity and mortality.
“These findings highlight that AYA cancer survivors are at risk for late and long-term cardiovascular complications from their treatment,” Hoover concluded in her presentation. “Continued surveillance is needed for cardiovascular risk factors and cardiovascular disease in the AYA cancer survivor population.
Since this population is also at increased risk for short-term as well as long-term health effects related to cancer treatments, the researchers assessed how this group of survivors were doing in adhering to health behaviors that can help mitigate the effects, such as physical activity, smoking cessation, alcohol avoidance, and maintaining a healthy diet.
The second literature review included peer-reviewed studies on AYA cancer survivors’ participation in health behaviors, as well as data on wellness outcomes, facilitators, and barriers to participation.
In the nine studies that met the inclusion criteria, Hoover and Mayer found that participation in healthy behaviors was associated with positive wellness outcomes, such as decreased depression and mood scores, as well as improved mood, self-esteem, and quality of life. The review also showed, however, that AYA cancer survivors were less likely to engage in behaviors such as following a healthy diet, avoiding alcohol, or being physically active.
In her presentation of this study, Hoover suggested that these young cancer survivors should be educated about the negative impact that cancer can have on their post-treatment life and the need to engage in healthy behaviors. In addition, AYA cancer survivors should receive guidance on how to adopt these healthy behaviors and well as any support needed to maintain adherence to these behaviors.
Hoover, a Hillman Scholar of Nursing Innovation, reported support from the Hillman Foundation.
No disclosures were noted for Mayer.