Awareness of Risk for Heart Disease May Mitigate Underdiagnosis in Childhood Cancer Survivors

Because of previously received cancer treatment, childhood cancer survivors may be at a higher risk of developing heart disease. However, the risks posed, such as high cholesterol, hypertension, high blood pressure and more, are often underdiagnosed and undertreated, according to a recent study.

The study, which was published in the Journal of the American Heart Association, included 571 cancer survivors and 345 age-matched individuals without a history of cancer. The results concluded that survivors were more likely to have a preexisting heart disease risk factor than those without a history of cancer.

Dr. Eric Chow, lead study author and pediatric oncologist at Fred Hutchinson Cancer Center in Seattle, told Heal® that this is because treatments, such as radiation and anthracycline chemotherapy, increase the probability of developing these risk factors.

Rates of underdiagnosing these risk factors were similar among both groups (27.1% for survivors and 26.1% for those without a history of cancer), but cancer survivors were more likely to be undertreated for these risk factors (21% compared with 13.9%, respectively). The most underdiagnosed and undertreated risk factors included hypertension (18.9%) and dyslipidemia (16.3%).

Chow explained that underdiagnosing is not uncommon, especially in a younger adult population.

“We tend to think of these conditions more as problems that affect older adults. So if there is someone in their 20s or 30s with higher blood pressure, as a provider ... they notice it, but it doesn’t strike them as it probably would for someone in their 50s or 60s,” he said.

Another challenge childhood cancer survivors may face when it comes to diagnosis and treating these risks is that they may not know they are at risk because they don’t remember the treatment they received, as they were so young, Chow explained. Thus, their access — and their physician’s access — to the treatment information may be limited.

In this case, Chow said it is important for current patients with cancer and survivors to advocate for themselves and understand what their risk of developing heart disease may be.

Of note, the study results also demonstrated that survivors who had more “self- efficacy” toward their care — meaning they were more willing or able to manage their own health care — were much less likely to be undertreated or underdiag- nosed.

“The ability to take ownership and manage their own health is associated, potentially, with better health outcomes,” Chow said. “But ... we don’t just inherit or are born with self-efficacy; that’s some- thing we learn and (is) an important area to improve on.”

With heart disease as the leading cause of noncancer mortality among this population, staying aware of their risk factors and advocating for their health is important for cancer survivors.

“One of the messages of the study is that although they can’t undo the chemotherapy or radiation, if (they) do have high blood pressure (or other risk factors), addressing those — at least we think — will reduce the risk of heart disease, (which is) at least something that can be actionable at this time,” Chow concluded.

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