Lifestyle factors associated concurrently and prospectively with co-morbid cardiovascular disease in a population-based cohort of colorectal cancer survivors
Introduction
Colorectal cancer is a commonly diagnosed cancer in Europe and its incidence increases rapidly with age.1 The risk of chronic conditions occurring concomitantly with colorectal cancer (such as cardiovascular disease; CVD) also increases with age.2 Colorectal cancer survivors have an elevated risk of co-morbid disease which can be attributed to genetic predisposition as well as shared lifestyle risk factors.3 Lifestyle risk factors common to colorectal cancer and other chronic diseases, and with CVD in particular, include overweight/obesity, physical inactivity, poor diet and smoking. Given the strong evidence that most chronic diseases are preventable through lifestyle modification4, lifestyle improvement following a cancer diagnosis may mitigate existing co-morbid chronic disease progression and reduce the risk of developing such diseases.
Co-morbid chronic conditions have a significant impact on the management of, and prognosis for, cancer survivors.5 Patients presenting with co-morbid conditions are usually excluded from clinical trials, and co-morbidity affects the presentation and recognition of cancer symptoms5, 6, 7, as well as post-operative morbidity. Further, co-morbid chronic conditions (especially CVD) can have a negative effect on colorectal cancer survival.8
A number of studies have documented the prevalence of co-morbid chronic conditions in colorectal cancer survivors.9 A recent population-based study found that 30% of colorectal cancer survivors had co-morbid conditions8, whilst another study reported that 35% of colorectal cancer survivors under 70 years, and 61% of those over 70 years of age, suffered from other chronic conditions which were higher than those observed in the general population.10 The most commonly observed co-morbid condition was CVD, followed by previously diagnosed cancers, hypertension, COPD and diabetes.10 In developed countries, CVD is a major cause of morbidity, mortality and economic burden. As trends in population ageing continue, the incidence of CVD and related health care costs are expected to continue to rise.11, 12 As such, it is essential to manage, or preferably prevent, CVD in those at high risk.
Whilst earlier studies have reported co-morbidity at the time of colorectal cancer diagnosis, they have not investigated co-morbidity development following cancer diagnosis. Further, there has been no previous report examining the association between modifiable lifestyle risk factors and co-morbid chronic illness among colorectal cancer survivors. Understanding how these lifestyle risk factors may be associated with the development of co-morbid disease could inform the development of behavioural interventions to reorient the trajectory of functional decline and ultimately improve survival for colorectal cancer survivors.
This study aims to: (i) assess the self-reported lifetime prevalence of CVD, one of the most commonly reported and costly co-morbid conditions among recently diagnosed colorectal cancer survivors; and (ii) examine the cross-sectional and prospective associations of modifiable lifestyle factors (body mass index, physical activity, television (TV) viewing, alcohol consumption and smoking) with co-morbid CVD.
Section snippets
Study sample
Data were collected as part of the Colorectal Cancer and Quality of Life Study, which has been described in detail elsewhere.13 In brief, all persons resident in Queensland, Australia, with a histologically confirmed diagnosis of a first, primary CRC, notified to the Queensland Cancer Registry between 1 January 2003 and 31 December 2004, were eligible for the study. Eligibility criteria also included: speaking English; having no hearing, speech or cognitive disabilities that would prevent
Results
Socio-demographic characteristics and lifestyle factors of study participants, and available data for non-participants, at each time-point are shown in Table 1.
Comparison of study participants with non-participants found no differences in the sex distribution between the groups at any time-point. However, the study sample did under-represent older (age 70–80 years) colorectal cancer survivors, those with rectal cancer, and those with more advanced disease (χ2 test, P < 0.05 for each).
Table 2
Discussion
In this population-based cohort of 1966 colorectal cancer survivors, 59% had co-morbid CVD at approximately 5 months post-diagnosis. Sixteen percent of the longitudinal sample (n = 1057), with no known CVD at baseline, developed a new cardiovascular condition by 36 months post-diagnosis. BMI was the strongest correlate of co-morbid CVD, with overweight/obese males and females more likely to suffer from hypercholesterolaemia, hypertension, diabetes and IHD. Similarly, those who were obese were more
Conclusion
Co-morbid CVD is common following colorectal cancer diagnosis and may have a negative impact on health outcomes and survival. In the developed world, CVD is a major cause of morbidity, mortality and economic burden11, 12 and it is essential to manage or preferably prevent CVD in those at high risk. Overweight or obese colorectal cancer survivors are more likely to suffer from co-morbid CVD, and interventions focusing on weight management and other modifiable lifestyle risk factors (including
Conflict of interest statement
None declared.
Role of the funding source
This study was funded by the Cancer Council Queensland, the peak non-government community-based cancer control organisation in Queensland, Australia.
Acknowledgement
This study was funded by the Cancer Council Queensland.
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Multidisciplinary prevention and management strategies for colorectal cancer and cardiovascular disease
2021, European Journal of Internal MedicineCitation Excerpt :For patients undergoing active CRC treatment, exposure to fluorouracil, patient age and the presence of conventional CVD risk factors further increases the risk for CVD. In particular, hypertension and diabetes had notable interactions with chemotherapy leading to the accelerated development of CVD and HF [[2],[65]]. Furthermore, Kenzik et al. observed differences by chemotherapeutic exposure: fluorouracil exposure was associated with high CVD risk, whereas the capecitabine treatment group showed higher HF rates [2].