Researchers Find an ‘Alarming’ Increase of Chronic Conditions in Cancer Survivors

Chronic conditions in adult cancer survivors have increased significantly over the past 20 years, especially in younger, non-Hispanic Black survivors, according to recent study results.

Dr. Charles Jiang, lead author of this study and medical oncology fellow at Roswell Park Comprehensive Cancer Center in Buffalo, New York, explained in an interview with CURE® that the number of cancer survivors is rapidly growing as treatments for cancer continue to improve, so it is important to understand what risk factors and chronic conditions this population might face 10 or 20 years into survivorship.

“I think it’s very important for (cancer survivors) to understand that they do have a higher risk of developing more medical conditions. And so, we should really be looking at it … on a populational level … so we can get a better understanding. So, both doctors, patients, as well as health care policymakers can really understand what we’re facing right now … and (what) probably (is) going to happen in the next 10 years,” he said.

The study, which was published in the journal Cancer,evaluated the trends and prevalence of chronic conditions among 30,728 cancer survivors from the year 2002 to 2018. Additionally, the researchers evaluated trends in multiple chronic conditions, when a person has three or more health conditions.

The results demonstrated an increased prevalence of hypertension (from 35.9% to 40.6%), diabetes (13.4% to 15.3%), kidney disease (4.2% to 5%), liver disease (3.1% to 4.4%) and morbid obesity (5.9% to 9.5%) among cancer survivors from 2002 to 2018. Jiang explained that the two primary reasons cancer survivors develop chronic conditions are that they may have had this chronic condition before a cancer diagnosis, or the effects of the cancer treatment played a part in the development of the condition.

Many of these chronic conditions can be associated with each other, Jiang added, noting that there is a growing global obesity pandemic, and especially in the United States. Obesity can result in increased risk of hypertension, diabetes and kidney disease, he explained, which may be the reason some cancer survivor’s experience these trends. Additionally, cancer treatment has gotten much better and resulted in patients living longer, giving them a longer period of time to develop these conditions.

“Now the treatment is getting much better. So (these) patients really got a chance to survive beyond their cancer and no become a cancer survivor. So that will also increase the prevalence of kidney disease,” he said.

It was also observed that the prevalence of multiple chronic conditions increased significantly from 4.7 million cancer survivors in 2001 to 8.1 million cancer survivors in 2018.

This increase was observed mostly among cancer survivors aged 18 to 44 years, male sex and who were non-Hispanic Black. Jiang noted this is one of the major findings of their study. He explained that this subgroup of cancer survivors tend to have a more unhealthy habits, which can increase their risk of health conditions. They also might not have access to great preventive care or after-diagnosis care as well as social support and transportation needs, which can affect how their cancer and survivorship is treated.

“(These) patients are the patients who need the care the most, but they just don’t have enough recourses…” he said.

Multiple chronic condition prevalence increased more rapidlyin young cancer survivors (from 18.4% to 28.4%)and non-Hispanic Black cancer survivors (56.8% to 60.4%) than those without a history of cancer (1.9% to 2.9% and 19.7% to 21.8%, respectively).

Jiang advises that “simple things matter” and patients and survivors of cancer should do everything they can to modify these chronic conditions to live a longer, healthier life; this included quitting smoking, exercising more and having a healthy diet.

“I think the key is that it is very alarming to see this rapid increase in … multiple chronic conditions in the younger population, because we know we’re doing such a good job and rapidly treating cancer nowadays compared to 20 years ago, we don’t want to lose (these) patients for entirely preventable reasons,” Jiang concluded.

On the other hand, chronic conditions such as ischemic heart disease, chronic obstructive pulmonary disease (COPD) and hepatitis all had significant decreases over the years (from 12.3% to 10.6%; 9.4% to 6.9%; and 5.9% to 4.5%, respectively). Jiang associated these to better treatment options that are available for hepatitis, as well as successful smoking cessation campaigns that have decreased the risk of COPD and heart disease.

Similar trends were seen in individuals without a cancer diagnoisis (454,505 individuals). However the decrease in ischemic heart disease and COPD, and the increasing trend of liver disease was more prevalent among cancer survivors.

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