Increased Risk of Cerebrovascular Events in Young Cancer Survivors: The Downside of Surviving Cancer.

Abstract

Article, see p 1194 Survival after cancer is rapidly improving because of advances in early detection (including screening programs) and cancer treatment.1 Although this finding seems like good news at first sight, it also extends the window for the occurrence of (long-term) complications. These complications include, among others, psychosocial effects, fertility problems, development of second malignant tumors, and risk of future cerebrovascular events.2 Particularly, cerebrovascular disease is associated with loss of independence because of motor deficits as well as cognitive deterioration. The rapid increase of cancer survival and the long life expectancy these survivors experience call for adequate quantitative information on the tumor-specific long-term risk of future cerebrovascular events. In this issue of Circulation , Bright and colleagues3 present this information on the risk of hospitalization for cerebrovascular events among 5-year cancer survivors diagnosed in individuals between 15 and 39 years of age based on data from the population-based TYACSS (Teenage and Young Adult Cancer Survivor Study) (N=178 962). They found that teenagers and young adults surviving cancer had a 40% increased risk of hospitalization for a cerebrovascular event compared with the general population, which was equivalent to 2782 cancer survivors hospitalized for a cerebrovascular complication among the entire TYACSS population during a median follow-up of 11.3 years. Patients who were treated for central nervous system tumors (standardized hospitalization ratios [SHR], 4.6; 95% confidence interval [CI], 4.3–5.0), head and neck tumors (SHR, 2.6; 95% CI, 2.2–3.1), and leukemia (SHR, 2.5; 95% CI, 1.9–3.1) had the highest risk of hospitalization for a cerebrovascular complication. The risk of hospitalization for a cerebral infarction was particularly increased among survivors of a central nervous system tumor >60 years of age, whereas this risk for survivors …