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Does Cardiovascular Mortality Overtake Cancer Mortality During Cancer Survivorship?: An English Retrospective Cohort
Helen Strongman1, Sarah Gadd1, Anthony A Matthews1,2
1Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Insights
Cardiovascular disease mortality overtakes cancer mortality in older cancer survivors over time. This shift occurs between 2-17 years post-diagnosis, depending on age and cancer type, highlighting long-term survivorship risks.
Area of Science:
- Oncology
- Cardiology
- Epidemiology
- Public Health
Background:
- Cancer survivors face elevated risks of developing cardiovascular diseases compared to the general population.
- Understanding long-term health trajectories in cancer survivorship is crucial for patient care.
Purpose of the Study:
- To determine if cardiovascular mortality surpasses cancer-specific mortality during cancer survivorship.
- To identify the time point at which cardiovascular disease becomes the leading cause of death in cancer survivors.
Main Methods:
- A large cohort study utilizing linked English electronic health records and death registration data.
- Inclusion of 104,028 adults (≥40 years) with a first diagnosis of one of nine common cancers, followed for at least one year post-diagnosis.
- Age-stratified mortality rates for cardiovascular disease and cancer were estimated using Poisson models, with crossover points determined by interpolation.
Main Results:
- Cardiovascular mortality surpassed primary cancer mortality between 2-11 years post-diagnosis in survivors aged ≥80 years.
- For survivors aged 60-79 years, this crossover occurred between 5-17 years post-diagnosis for seven cancer types.
- Cardiovascular mortality did not overtake cancer mortality in patients aged 40-59 years during the observation period, with the exception of uterine cancer survivors.
Conclusions:
- In older cancer survivors (≥60 years), cardiovascular mortality becomes the dominant cause of death over time, surpassing primary cancer mortality.
- The findings underscore the importance of long-term cardiovascular monitoring in cancer survivorship, particularly for older individuals.
- While cardiovascular disease may overtake primary cancer mortality, it does not always surpass total cancer mortality.
Background:
Cancer survivors have a higher risk for developing cardiovascular diseases than the general population.
Objectives:
The aim of this study was to investigate whether cardiovascular mortality overtakes cancer-specific mortality during cancer survivorship and, if so, at what point cardiovascular disease becomes the dominant cause of death.
Methods:
This cohort study used linked English electronic health records, including death registration data. The study population included 104,028 adults ≥40 years of age whose first cancer diagnosis was for 1 of 9 common cancers and who were alive and followed up at least 1 year after diagnosis. Age-stratified mortality rates were estimated from cardiovascular disease or cancer by predicting from Poisson models incorporating categorical age at diagnosis and time since diagnosis. Where cardiovascular disease mortality overtook cancer mortality, the crossover point was estimated using interpolation.
Results:
Mortality from cardiovascular causes overtook mortality due to the primary cancer at 2 to 11 years after cancer diagnosis in survivors of all 9 cancer types ≥80 years of age at diagnosis and after 5 to 17 years in survivors of 7 cancer types 60 to 79 years of age at diagnosis. Cardiovascular mortality overtook all cancer mortality for 6 and 2 cancer sites in the ≥80-year and 60- to 79-year age groups, respectively, over a longer time period. Cardiovascular mortality did not overtake cancer mortality during the observation period in patients aged 40 to 59 years, except among survivors of uterine cancer.
Conclusions:
In older survivors of 9 common cancers, cardiovascular mortality becomes dominant over mortality from the primary cancer, though not always over total cancer mortality, as time passes since cancer diagnosis.
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