Risk In Cancer Survivors Research Articles

Pre-Diagnosis Diet and Physical Activity and Risk of Cardiovascular Disease Mortality among Female Cancer Survivors

Simple SummaryThe number of cancer survivors is increasing; however, cancer survivors are at an increased risk of cardiovascular diseases (CVD) and CVD mortality. Therefore, it is pertinent to understand how lifestyle choices such as dietary patterns and physical activity are associated with this risk. Little is known about the relationship of pre-cancer diagnosis diet quality and physical activity (PA) with CVD among cancer survivors. Most studies have focused on post-cancer diagnosis risk factors, without accounting for their status in the pre-diagnosis period or interaction on CVD mortality. We examined pre-cancer diagnosis diet quality and physical activity in relation with CVD mortality risk in female cancer survivors from the California Teachers Study cohort. We hypothesized that higher diet quality scores and higher physical activity levels prior to cancer diagnosis would be associated with lower risk of CVD mortality in female cancer survivors.Sub-optimal diet and physical activity (PA) levels have been associated with increased risk of cardiovascular disease (CVD) mortality. The relationship between pre-cancer diagnosis diet quality and PA level on CVD mortality risk in cancer survivors is unclear. We examined the association between pre-cancer diagnosis diet quality and leisure-time PA and their interaction on CVD mortality in cancer survivors. Diet quality was characterized by the Alternative Mediterranean Diet Index (aMED). Leisure-time PA was converted to a metabolic equivalent of task hours per week (MET-h/wk). During a median of 6.3 years of follow-up of 18,533 female cancer survivors, we identified 915 CVD deaths. aMED score was not associated with CVD mortality. PA level was inversely associated with CVD mortality (HRQ1-Q4 = 0.74; 95% CI: 0.61–0.88; Ptrend = 0.0014). Compared to cancer survivors with the lowest pre-diagnosis aMED score and PA level, cancer survivors with higher aMED scores and higher MET-hrs/wk were at a 33% lower risk of CVD mortality (HR = 0.67; 95% CI: 0.52–0.87). Overall, this study shows PA to be a strong predictor of CVD mortality in female cancer survivors. Our observations support the importance of PA throughout the lifecycle in lowering CVD mortality risk.

Pre-diagnosis Diet and Physical Activity and Risk of Cardiovascular Disease Mortality Among Female Cancer Survivors

ObjectivesBetter diet quality and higher physical activity (PA) levels have been associated with lower risk of cardiovascular disease (CVD) mortality, but the relationship between pre- cancer diagnosis diet quality and PA level on CVD mortality risk in cancer survivors is unclear. We examined the association between pre-cancer diagnosis diet quality and leisure time PA, and their interaction, on CVD mortality in cancer survivors.MethodsFemale cancer survivors who were diagnosed during follow-up and had no history of cancer, stroke, or heart attack at baseline were identified. Analyses excluded: (1) participants who lived outside California at baseline, (3) missing food frequency questionnaire (FFQ) or recreational PA data, (4) total energy intake less than 600 kilocalories/day or above 3,500 kilocalories/day or (5) survivors whose cancer was diagnosed within 1 year of the baseline questionnaire. Diet quality was characterized by the Alternative Mediterranean Diet Index (aMED). Leisure time PA was converted to metabolic equivalent of task hours per week (MET-h/wk). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards regression models.ResultsDuring a median of 6.3 years of follow-up of 18,533 female cancer survivors, we identified 915 CVD deaths. aMED did not show a significant association with CVD mortality. Pre-cancer diagnosis PA was independently associated with lower CVD mortality (HRQ1-Q4 = 0.74; 95% CI: 0.61–0.88; Ptrend < 0.0014). No significant interaction was observed between pre-cancer diagnosis aMED score and PA with CVD mortality but compared to participants with the lowest pre-diagnosis aMED score and physical activity levels, participants with higher aMED scores and higher MET-hrs/wk were at 33% lower risk of CVD mortality (HR = 0.67; 95% CI: 0.52–0.87).ConclusionsOverall, this study shows PA level to be a strong predictor of CVD mortality in female cancer survivors. Our observations support the importance of PA throughout the lifecycle in decreasing risk of CVD mortality. Primary care physicians (PCPs) should continue to relay the significance of PA level in their healthy patients prior to a potential diagnosis of cancer.Funding SourcesNational Cancer Institute of the National Institutes of Health.

Abstract 9712: Impact of Heart Failure on Prognosis in Cancer Patients (Kurume-CREO Study)

Introduction: With recent progress in treatment of cancers, cancer survivors have an increased risk of cardiovascular diseases (CVDs) due to aging or toxicities of anti-cancer drugs. However, more evidence regarding CVD risk in cancer survivors is required. Hypothesis: CVD as comorbidity has a big impact on prognosis in cancer patients. Methods: We enrolled 400 patients with hematological malignancy and breast cancer visiting Kurume University Hospital between October in 2016 and December in 2019 in Kurume-CREO study, a prospective observational study. We evaluated blood test and chest X-ray, electrocardiogram and echocardiography at baseline and follow up every 6 months after baseline. Outcomes were defined as all-cause deaths and CVD mortality due to myocardial infarction, heart failure (HF) and pulmonary thromboembolism. HF was defined as either N-terminal prohormone of brain natriuretic peptide elevation or findings in chest X-ray or diagnosed HF by cardiologists. We followed up until September 23th in 2019. Results: Mean age (± standard deviation) of participants was 64.1 (± 12.9) years old, and 280 of 400 patients (70%) were enrolled before chemotherapy. Among hematological malignancies, non-Hodgkin’s lymphoma (n=223, 68.2%) and multiple myeloma (n=55, 16.8%) were most frequently observed. During the follow-up period, 85 patients (21.3%) died, 2 patients (0.5%) died from CVD and 50 patients (12.5%) had HF. Survival curves showed a significantly worse survival rate in patients with hematological malignancy compared to those with breast cancer (Log-rank p = 0.002)(Fig 1). All cancer patients with HF during the period had significantly worse prognosis than those without HF (Log-rank p = 0.003)(Fig 2). Conclusions: Mortality in cancer patients with HF comorbidities was significantly higher than in those without HF. CVD death was very rare in the present study, but HF comorbidity was a significant prognostic factor in cancer.

Testing for clonal hematopoiesis of indeterminate potential in breast cancer survivors.

e24108 Background: Clonal hematopoiesis of Indeterminate Potential (CHIP) is associated with adverse clinical outcomes including increased risk of hematologic malignancies and heart disease. Limited data suggest an increased prevalence of CHIP in patients treated for solid tumors, particularly after exposure to radiation and chemotherapy. CHIP testing may inform risk-reduction strategies for cancer survivors. Little is known about patient knowledge, attitudes, and preferences regarding CHIP testing. Methods: We surveyed survivors without history of recurrence participating in an ongoing prospective cohort study of young women with breast cancer (BC). The survey was sent by email and included an introduction to CHIP including risk factors and clinical associations. Respondents then reviewed a vignette and were asked about CHIP testing preferences (definitely/probably test vs. definitely/probably not test) considering sequentially: 1) population-based 10-year risk of BC recurrence, hematological malignancy and heart disease; 2) estimated increase in these risks with CHIP; 3) current CHIP management; 4) a dedicated CHIP clinic; and 5) a theoretical CHIP treatment. Changes in preferences from the prior scenario were evaluated with the McNemar's test using a type I error rate of 5%. Results: 528/642 (82.2%) eligible women responded to the survey, at a median age of 46 (range: 31-54) years (median time from diagnosis: 108 months (range: 60-168)), and 88% were white. Most had stage 1/2 BC (78.8%) and had received chemotherapy (73.1%) and/or radiation (61.9%). 93.6% had never heard of CHIP prior to survey. After initial patient vignette presentation, most women (87.1%,) recommended CHIP testing if offered. Preferences for testing decreased (p&lt;0.05) when considering population-based risks, with 11.1% shifting their preference from CHIP testing to not testing. After considering increased risks associated with CHIP, interest in testing increased (p&lt;0.05), with 10.1% shifting their preference to testing. Interest significantly (p&lt;0.05) increased with the possibility of managing CHIP through a clinic or a hypothetical CHIP treatment, with 7.2% and 14.1% switching their preferences towards testing, respectively. Finally, 75.8% responded that they themselves, after learning about CHIP and reviewing the vignette, would want to have CHIP testing; 28.2% reported that learning about CHIP and the associated risks caused them at least moderate anxiety. Conclusion: Few young BC survivors were aware of CHIP yet most indicated an interest in testing after learning about it. Testing preferences were influenced by risks presented and potential management strategies. Findings highlight the importance of effective risk communication and the need for adequate psychosocial support when considering testing for CHIP and other potential clinical biomarkers predictive of cancer and other medical risks in cancer survivors.

Prediagnosis alcohol intake and metachronous cancer risk in cancer survivors: A prospective cohort study.

Alcohol consumption is a known cause of cancer, but its role in the etiology of second primary (metachronous) cancer is uncertain. Associations between alcohol intake up until study enrollment (prediagnosis) and risk of metachronous cancer were estimated using 9435 participants in the Melbourne Collaborative Cohort Study who were diagnosed with their first invasive cancer after enrollment (1990-1994). Follow-up was from date of first invasive cancer until diagnosis of metachronous cancer, death or censor date (February 2018), whichever came first. Alcohol intake for 10-year periods from age 20 until decade encompassing baseline using recalled beverage-specific frequency and quantity was used to calculate baseline and lifetime intakes, and group-based intake trajectories. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for potential confounders. After a mean follow-up of 7 years, 1512 metachronous cancers were identified. A 10 g/d increment in prediagnosis lifetime alcohol intake (HR = 1.03, 95% CI = 1.00-1.06; Pvalue = .02) and an intake of ≥60 g/d (HR = 1.32, 95% CI = 1.01-1.73) were associated with increased metachronous cancer risk. We observed positive associations (per 10 g/d increment) for metachronous colorectal (HR = 1.07, 95% CI = 1.00-1.14), upper aero-digestive tract (UADT) (HR = 1.16, 95% CI = 1.00-1.34) and kidney cancer (HR = 1.24, 95% CI = 1.10-1.39). Although these findings were partly explained by effects of smoking, the association for kidney cancer remained unchanged when current smokers or obese individuals were excluded. Alcohol intake trajectories over the life course confirmed associations with metachronous cancer risk. Prediagnosis long-term alcohol intake, and particularly heavy drinking, may increase the risk of metachronous cancer, particularly of the colorectum, UADT and kidney.

Cardiometabolic Risk, Part 2: Indirect Cardiotoxicity in Cancer Survivors - The Emerging Role of Metabolic Syndrome.

Cardiovascular diseases represent one of the most common and serious late complications of anticancer treatments. In the general population, metabolic syndrome is closely related to the risk of cardiovascular events and mortality. In recent years, metabolic syndrome has gained attention as a crucial determinant of long-term cardiovascular risk in cancer survivors. Several risk factors have been associated with metabolic syndrome after cancer treatments, even if the pathophysiological mechanisms of this association are not fully understood. This chapter reviews the clinical features of metabolic syndrome in cancer survivors, analyzing in more detail patients treated with hormonal therapy and survivors of hematopoietic stem cell transplantation, who are burdened with a greater cardiovascular risk. Moreover, the role of lifestyle factors in the development of metabolic syndrome is discussed as well as the screening strategy for the early detection of metabolic alterations in cancer survivors. Finally, we discuss the available recommendations for cardiovascular risk assessment in cancer survivors and treatments for metabolic syndrome in this specific context.

Abstract 16526: The Performance of the American College of Cardiology/American Heart Association 2013 Pooled Cohort Equations in Cancer Survivors

Introduction: Cancer survivors may have greater atherosclerotic cardiovascular disease (ASCVD) risk, due in part to cardiotoxic cancer treatments. We tested how accurately the American College of Cardiology/American Heart Association 2013 pooled cohort equations (PCEs) predict 10-year ASCVD risk in cancer survivors. Objective: To estimate the calibration and discrimination of PCEs in cancer survivors as compared to non-cancer participants in the Atherosclerosis Risk in Communities (ARIC) study. Methods: We evaluated the PCEs performance among 992 cancer survivors and 3320 cancer-free participants (controls) who were free of ASCVD (defined as myocardial infarction, coronary heart disease death, or stroke) and did not use statins. Each cancer survivor was incidence-density matched with up to five controls by age (within 5 years), race, sex, and study center. Follow-up started at the index visit: the first study visit that occurred at least one year after the diagnosis date of the cancer survivor (1-17 years after diagnosis) and finished at the ASCVD event, death, or end of follow-up. PCE predictors were measured at the index visit. Calibration of PCEs predictions of 10-year ASCVD risk in cancer survivors and controls was assessed using Hosmer-Lemeshow chi-square tests. Discrimination was measured via Harrell’s C-index. Results: 54 (5%) and 224 (7%) ASCVD events were observed in 5411 and 22212 person-years among cancer survivors and controls, respectively. Median age was 69 years. 18% were Black. 51% were female. The PCEs overestimated the risk of CVD among cancer survivors as well as controls (Table 1). Discrimination was moderate in cancer survivors (C=0.73) and poorer than in controls (C=0.77). Conclusions: The PCEs overestimated ASCVD risk in cancer survivors as well as controls. Support: NHLBI, NCI, NPCR

Risk Factors of Cardiovascular Disease according to Alcohol Behavioral Change after Cancer Diagnosis.

BackgroundProblem drinking increases the incidence of all-cause mortality and specific cancers, and persistent drinking is associated with cardiovascular disease in certain cancer survivors. This study analyzed the cardiovascular risk factors before and after diagnosis in Korean cancer survivors.MethodsData for the period between 2002 and 2013 were collected from the National Health Insurance Service Health-Examinee Cohort Database. Among the 27,835 patients included, those with moderate alcohol consumption before and after cancer diagnosis were excluded. Problem drinking was defined as males under 65 years consuming over 14 glasses a week, and males over 65 years or females consuming over seven glasses a week. A t-test, chi-square test, and linear regression analysis were performed for differences in cardiovascular risk factors and differences according to cancer types.ResultsThere was a difference in the body mass index, systolic and diastolic blood pressure, and total cholesterol among patients who became moderate drinkers after diagnosis, but fasting blood glucose did not show any significant changes. Risk factors for cardiovascular disease were analyzed in patients with liver, stomach, rectal, and breast cancer with improved drinking behavior, and there were significant differences in body mass index, systolic and diastolic blood pressure, fasting blood glucose, and total cholesterol in stomach cancer patients.ConclusionModerate drinking can lower cardiovascular risk in cancer survivors, and among the many drinking-related cancers, stomach cancer patients demonstrated significantly reduced cardiovascular risk factors.

Abstract P5-14-02: Yoga for chemotherapy-induced peripheral neuropathy and fall risk in breast and gynecological cancer survivors: A pilot study

Abstract Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, debilitating and dose-limiting side effect of neurotoxic chemotherapies that worsens quality of life and increases fall risk in cancer survivors. CIPN is painful and poorly managed with pharmacological agents.This pilot study assessed the preliminary effect of yoga on CIPN symptom severity and fall risk in cancer survivors.Methods: Breast and gynecological (GYN) cancer survivors with persistent, moderate-to-severe CIPN were randomized to yoga and usual care (UC) control arms. The yoga arm practiced Hatha yoga for 60 minutes daily via an in-person group class (2 times/week) and at home using a study-provided instructional video (5 times/week), and the UC arm received usual care for 8 weeks. Main study outcomes included a numeric rating scale (NRS) of CIPN pain, numbness and tingling (higher score indicates worse symptom); the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicitysubscale (FACT-GOG/Ntx) (higher score indicates improved symptoms); and functional reach (FR) test, an objective balance test used to evaluate fall risk (higher score indicates lower risk of fall). Mean changes from baseline to week 8 were calculated for each outcome measure and compared between treatment arms using two-sample t-tests. Results: From 2/2018 to 5/2019, 41 female cancer survivors (92.7% breast, 7.3% GYN; mean (SD) age 62.6 (10.2) years; 53.7% white/non-Hispanic, 19.5% African American, 12.2% Asian, 12.2% other) were enrolled and randomized to yoga (N=21) and UC (N=20) arms. At week 8, mean NRS pain decreased by 2.06 points (95% CI [-3.27, -0.86]) in the yoga arm, and 0.65 points [-2.08, 0.78] in the UC arm (p=0.12). No statistically significant change was observed in NRS numbness and tingling for yoga versus UC arms (both p&amp;gt;0.5). FACT-GOG/Ntx improved by 4.56 points [-1.84, 7.29] in the yoga arm, and 1.37 points [-0.51, 3.25] in the UC arm (p=0.05). FR improved by 3.08 inches [-1.43, 4.73] in the yoga arm, and decreased 0.59 inches [-0.51, 3.25] in the UC arm (p=0.003). Four yoga and 3 UC subjects reported a total of 11 adverse events deemed possibly related to the yoga intervention (all grade 1). Conclusion: Among breast and GYN cancer survivors with moderate-to-severe CIPN, yoga showed promising effects for improving neuropathy-related pain and quality of life, and for reducing fall risk. An adequately-powered and appropriately-controlled trial is warranted to confirm the specific and long-term effects of yoga on CIPN symptoms and fall prevention. Citation Format: Ting Bao, Madeline Hooper, Raymond Baser, Patricia Chen, Lauren Piulson, Clare Patterson, Tina Paul, Connie Chen, Qing Li, Katherine Panageas, Iris Zhi, Victoria Blinder, Mark Robson, Andrew Seidman, Jun Mao. Yoga for chemotherapy-induced peripheral neuropathy and fall risk in breast and gynecological cancer survivors: A pilot study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-14-02.

Circuit resistance training and cardiovascular health in breast cancer survivors.

Cardiovascular disease is the leading cause of death in breast cancer survivors. While evidence shows circuit resistance training (CRT) is effective for improving muscle and cardiorespiratory fitness, whether CRT is an efficacious therapy for decreasing cardiovascular risk in cancer survivors is unclear. Fifty-one breast cancer survivors were recruited to either 12weeks CRT (n=26), or a non-exercising wait-list control (n=25). Two supervised 60min CRT sessions per week were undertaken, comprising resistance and functional exercises, and aerobic exercise stations. Primary outcome measure was the gold-standard assessment of arterial stiffness, aortic pulse wave velocity (PWV). Secondary outcomes included: cardiorespiratory fitness (CRF), upper and lower body strength, arterial wave reflections, central blood pressure and rate pressure product. Compared to the control group, the CRT group had a statistically significant medium effect decrease in PWV 0.9m/s (95% CI: 0.1, 1.7). There were large effect improvements in VO2 max (4.3mlkg-1 min-1 , 95% CI: 5.8, 2.8), upper and lower body strength (3.7kg, 95% CI: 1.9, 5.6 and 10.4kg, 1.6, 19.1) respectively. Findings support the existing literature demonstrating that 12weeks CRT improves muscle and cardiorespiratory fitness and is also an effective strategy for decreasing a proven cardiovascular risk factor in breast cancer survivors.

Cardiovascular disease risk in survivors of 20 adult cancers.

11571 Background: There are concerns about long-term cardiovascular disease (CVD) risk in cancer survivors, but few studies have quantified the risks for a wide range of cancers and specific CVD outcomes. Methods: Using UK electronic health records, we identified cohorts of adults alive one year after a cancer diagnosis at 20 different sites. Risks of a range of CVD outcomes were compared to age, sex and general practice matched cancer free controls using Cox regression; crude and adjusted models were compared to investigate the role of shared cancer/CVD risk factors (e.g. smoking and diabetes). Results: 126 120 cancer survivors and 603 144 controls were followed over a median (IQR) 4.6 (2.5-8.1) and 5.6 (3.2-9.2) years. Crude and adjusted hazard ratios (HRs) were similar. In adjusted models, there was strong evidence (p&lt;0.01) of increased risk of CVDs among cancer survivors compared with controls: venous thromboembolism (VTE, 18 cancers), heart failure/cardiomyopathy (7 cancers), arrhythmia (4 cancers), and stroke (3 cancers). In stratified analyses HRs were higher in younger people and continued beyond 5 years post diagnosis. Conclusions: We found increased long term CVD risk among survivors of several cancers compared to the general population, which varied by cancer site and specific CVD outcome.[Table: see text]

Cost-Effectiveness of Colonoscopy-Based Colorectal Cancer Screening in Childhood Cancer Survivors.

BackgroundChildhood cancer survivors (CCS) are at increased risk of developing colorectal cancer (CRC) compared to the general population, especially those previously exposed to abdominal or pelvic radiation therapy (APRT). However, the benefits and costs of CRC screening in CCS are unclear. In this study, we evaluated the cost-effectiveness of early-initiated colonoscopy screening in CCS.MethodsWe adjusted a previously validated model of CRC screening in the US population (MISCAN-Colon) to reflect CRC and other-cause mortality risk in CCS. We evaluated 91 colonoscopy screening strategies varying in screening interval, age to start, and age to stop screening for all CCS combined and for those treated with or without APRT. Primary outcomes were CRC deaths averted (compared to no screening) and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per life-years gained (LYG) was used to determine the optimal screening strategy.ResultsCompared to no screening, the US Preventive Services Task Force’s average risk screening schedule prevented up to 73.2% of CRC deaths in CCS. The optimal strategy of screening every 10 years from age 40 to 60 years averted 79.2% of deaths, with ICER of $67 000/LYG. Among CCS treated with APRT, colonoscopy every 10 years from age 35 to 65 years was optimal (CRC deaths averted: 82.3%; ICER: $92 000/LYG), whereas among those not previously treated with APRT, screening from age 45 to 55 years every 10 years was optimal (CRC deaths averted: 72.7%; ICER: $57 000/LYG).ConclusionsEarly initiation of colonoscopy screening for CCS is cost-effective, especially among those treated with APRT.

Pregnancy after cancer: Does timing of conception affect infant health?

The objective of this retrospective cohort study was to determine whether women who conceive soon after treatment for cancer have higher risks of adverse pregnancy outcomes. Vital records data were linked to cancer registry diagnosis and treatment information in 3 US states. Women who conceived their first pregnancy after diagnosis between ages 20 and 45 years with any invasive cancer or ductal carcinoma in situ were eligible. Log-binomial models were used to compare risks in cancer survivors who conceived in each interval to the risks in matched comparison births to women without cancer. Women who conceived ≤1 year after starting chemotherapy for any cancer had higher risks of preterm birth than comparison women (chemotherapy alone: relative risk [RR], 1.9; 95% confidence interval [CI], 1.3-2.7; chemotherapy with radiation: RR, 2.4; 95% CI, 1.6-3.6); women who conceived ≥1 year after starting chemotherapy without radiation or ≥2 years after chemotherapy with radiation did not. In analyses imputing the treatment end date for breast cancer survivors, those who conceived ≥1 year after finishing chemotherapy with or without radiation had no higher risks than women without cancer. The risk of preterm birth in cervical cancer survivors largely persisted but was somewhat lower in pregnancies conceived after the first year (for pregnancies conceived ≤1 year after diagnosis: RR, 3.5; 95% CI, 2.2-5.4; for pregnancies conceived >1 year after diagnosis: RR, 2.4; 95% CI, 1.6-3.5). In women who received chemotherapy, the higher risk of preterm birth was limited to those survivors who had short intervals between treatment and conception.Cancer 2018;124:000-000.

Cardiovascular Risk in Cancer Survivors.

As the number of cancer survivors continues to rise with improved early-detection methods and advancing therapies, along with it, there come adverse health outcomes as a result of physiological and psychological effects of cancer, as well as adverse effects of cancer treatment itself. This paper reviews the risk of cardiovascular disease in cancer survivors. Cancer survivors are at higher risk of having modifiable cardiovascular (CV) risk factors, such as hypertension, diabetes mellitus, obesity, tobacco smoking, and physical inactivity. Cardiotoxicity is a well-established adverse effect of various anticancer regimens, which further elevates the cardiovascular risk in cancer patients. The increased risk of CVD and CVD-related death in cancer survivors is likely to be multifactorial, involving cardiotoxic effects of cancer treatments as well as comorbidities and harmful lifestyle habits. Targeting and managing known cardiac risk factors should be a main target in CVD prevention in cancer survivors.

Sarcopenia in cancer survivors is associated with increased cardiovascular disease risk.

The aim of this study was to assess the association between sarcopenia and cardiovascular disease (CVD) risk in cancer survivors. We analyzed a consecutive series of 683 cancer survivors from the Korean National Health and Nutritional Exam Survey (2008-2011years). Sarcopenia was defined as the appendicular skeletal muscle mass divided by weight (Kg) < 1 standard deviation below the sex-specific healthy population aged 20-39years. CVD risks were assessed using the Framingham Risk Score (FRS), which were divided by tertile. Predictors of higher shift of FRS tertile by sex were calculated by stratified ordinal logistic regression analyses. Proportions of sarcopenia were 24.2% in males and 22.5% in females. Sarcopenic survivors were more likely to have a higher body mass index, waist circumference, blood pressure and fasting glucose level, and a lower high-density lipoprotein compared to those without sarcopenia. Sarcopenia was associated with a higher shift of FRS tertile (common odds ratio, 2.67; 95% confidence interval, 1.18-6.52, P < 0.001) in males. However, this association was not significant in female survivors. Sarcopenia was associated with an increased CVD risk in Korean male cancer survivors. Interventions to prevent sarcopenia may be necessary to improve cardiovascular burden in cancer survivors.

Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis.

The aim of the present systematic review and meta-analysis was to gain further insight into the effects of adherence to Mediterranean Diet (MedD) on risk of overall cancer mortality, risk of different types of cancer, and cancer mortality and recurrence risk in cancer survivors. Literature search was performed using the electronic databases PubMed, and Scopus until 25 August 2017. We included randomized trials (RCTs), cohort (for specific tumors only incidence cases were used) studies, and case-control studies. Study-specific risk ratios, hazard ratios, and odds ratios (RR/HR/OR) were pooled using a random effects model. Observational studies (cohort and case-control studies), and intervention trials were meta-analyzed separately. The updated review process showed 27 studies that were not included in the previous meta-analysis (total number of studies evaluated: 83 studies). An overall population of 2,130,753 subjects was included in the present update. The highest adherence score to a MedD was inversely associated with a lower risk of cancer mortality (RRcohort: 0.86, 95% CI 0.81 to 0.91, I2 = 82%; n = 14 studies), colorectal cancer (RRobservational: 0.82, 95% CI 0.75 to 0.88, I2 = 73%; n = 11 studies), breast cancer (RRRCT: 0.43, 95% CI 0.21 to 0.88, n = 1 study) (RRobservational: 0.92, 95% CI 0.87 to 0.96, I2 = 22%, n = 16 studies), gastric cancer (RRobservational: 0.72, 95% CI 0.60 to 0.86, I2 = 55%; n = 4 studies), liver cancer (RRobservational: 0.58, 95% CI 0.46 to 0.73, I2 = 0%; n = 2 studies), head and neck cancer (RRobservational: 0.49, 95% CI 0.37 to 0.66, I2 = 87%; n = 7 studies), and prostate cancer (RRobservational: 0.96, 95% CI 0.92 to 1.00, I2 = 0%; n = 6 studies). Among cancer survivors, the association between the adherence to the highest MedD category and risk of cancer mortality, and cancer recurrence was not statistically significant. Pooled analyses of individual components of the MedD revealed that the protective effects appear to be most attributable to fruits, vegetables, and whole grains. The updated meta-analysis confirms an important inverse association between adherence to a MedD and cancer mortality and risk of several cancer types, especially colorectal cancer. These observed beneficial effects are mainly driven by higher intakes of fruits, vegetables, and whole grains. Moreover, we were able to report for the first time a small decrease in breast cancer risk (6%) by pooling seven cohort studies.

Long-term and late treatment consequences: endocrine and metabolic effects.

Cancer therapies often result in the 'late effect of cancer treatment' whereby secondary health complications emerge years after radiotherapy and chemotherapy. This review focuses on endocrine and metabolic consequences in adult cancer survivors as late treatment effects. Endocrine and metabolic disorders are among the most common late effects. Endocrine disorders include hypopituitarism, which leads to growth hormone deficiency, hypogonadism, adrenal insufficiency and hypothyroidism and related clinical manifestations. Hypogonadism in particular is associated with a wide range of health complications requiring input from the like of endocrine and fertility specialists. Immune checkpoint inhibitors are novel anticancer agents, some of which are uniquely associated with hypophysitis which requires early recognition and management, including steroid replacement. Metabolic syndrome, a significant risk for cardiovascular disease, is highly prevalent. Although the effects of cranial irradiation on the hypothalamic-pituitary system are more apparent, the relationship between chemotherapy and endocrine/metabolic disorders remains to be elucidated. There exist published guidelines for monitoring endocrine and cardiometabolic risk in cancer survivors, but the extent of monitoring appears insufficient. Regular monitoring and early management of endocrine/metabolic disorders is required to prevent the elevated rates of health complications after cancer treatment, and thereby improve cancer survivorship.

Cardiovascular Risk in Survivors of Cancer.

Survivors of childhood and adult cancers face increased risk of cardiovascular disease. We review the current evidence base and guidelines for this rapidly growing population. Research continues to show that cardiovascular disease is an important cause of morbidity and mortality in cancer survivors. Cardiotoxicity related to chemotherapy and radiotherapy accounts for part of this increased risk. There is emerging evidence that cancer and cardiovascular disease share a similar biology and risk factors. At present, there are several guidelines and consensus recommendations for the management of cardiovascular risk in cancer survivors. The evidence base is accumulating though additional research is necessary to demonstrate improved outcomes and comparative effectiveness.

Associations between cancer and Alzheimer's disease in a U.S. Medicare population.

Several studies have reported bidirectional inverse associations between cancer and Alzheimer's disease (AD). This study evaluates these relationships in a Medicare population. Using Surveillance, Epidemiology, and End Results (SEER) linked to Medicare data, 1992–2005, we evaluated cancer risks following AD in a case–control study of 836,947 cancer cases and 142,869 controls as well as AD risk after cancer in 742,809 cancer patients and a non‐cancer group of 420,518. We applied unconditional logistic regression to estimate odds ratios (ORs) and Cox proportional hazards models to estimate hazards ratios (HRs). We also evaluated cancer in relation to automobile injuries as a negative control to explore potential study biases. In the case–control analysis, cancer cases were less likely to have a prior diagnosis of AD than controls (OR = 0.86; 95% CI = 0.81–0.92). Cancer cases were also less likely than controls to have prior injuries from automobile accidents to the same degree (OR = 0.83; 95% CI = 0.78–0.88). In the prospective cohort, there was a lower risk observed in cancer survivors, HR = 0.87 (95% CI = 0.84–0.90). In contrast, there was no association between cancer diagnosis and subsequent automobile accident injuries (HR = 1.03; 95% CI = 0.98–1.07). That cancer risks were similarly reduced after both AD and automobile injuries suggest biases against detecting cancer in persons with unrelated medical conditions. The modestly lower AD risk in cancer survivors may reflect underdiagnosis of AD in those with a serious illness. This study does not support a relationship between cancer and AD.

Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis of observational studies.

The aim of the present systematic review and meta‐analysis of observational studies was to gain further insight into the effects of adherence to Mediterranean Diet (MD) on overall cancer mortality, incidence of different types of cancer, and cancer mortality risk in cancer survivors. Literature search was performed using the electronic databases PubMed, and EMBASE until 2 July 2015. We included either cohort (for specific tumors only incidence cases were used) or case–control studies. Study specific risk ratios, hazard ratios, and odds ratios (RR/HR/OR) were pooled using a random effect model. The updated review process showed 23 observational studies that were not included in the previous meta‐analysis (total number of studies evaluated: 56 observational studies). An overall population of 1,784,404 subjects was included in the present update. The highest adherence score to an MD was significantly associated with a lower risk of all‐cause cancer mortality (RR: 0.87, 95% CI 0.81–0.93, I 2 = 84%), colorectal cancer (RR: 0.83, 95% CI 0.76–0.89, I 2 = 56%), breast cancer (RR: 0.93, 95% CI 0.87–0.99, I 2=15%), gastric cancer (RR: 0.73, 95% CI 0.55–0.97, I 2 = 66%), prostate cancer (RR: 0.96, 95% CI 0.92–1.00, I 2 = 0%), liver cancer (RR: 0.58, 95% CI 0.46–0.73, I 2 = 0%), head and neck cancer (RR: 0.40, 95% CI 0.24–0.66, I 2 = 90%), pancreatic cancer (RR: 0.48, 95% CI 0.35–0.66), and respiratory cancer (RR: 0.10, 95% CI 0.01–0.70). No significant association could be observed for esophageal/ovarian/endometrial/and bladder cancer, respectively. Among cancer survivors, the association between the adherence to the highest MD category and risk of cancer mortality, and cancer recurrence was not statistically significant. The updated meta‐analyses confirm a prominent and consistent inverse association provided by adherence to an MD in relation to cancer mortality and risk of several cancer types.