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Review
. 2022 Jun 21;4(2):149-165.
doi: 10.1016/j.jaccao.2022.03.005. eCollection 2022 Jun.

Cardiometabolic Comorbidities in Cancer Survivors: JACC: CardioOncology State-of-the-Art Review

Leah L Zullig  1   2 , Anthony D Sung  3 , Michel G Khouri  3 , Shelley Jazowski  1 , Nishant P Shah  3 , Andrea Sitlinger  3 , Dan V Blalock  2   4 , Colette Whitney  4   5 , Robin Kikuchi  6 , Hayden B Bosworth  1   2   3   4 , Matthew J Crowley  2   3 , Karen M Goldstein  2   3 , Igor Klem  3 , Kevin C Oeffinger  3 , Susan Dent  3
Affiliations
Review

Cardiometabolic Comorbidities in Cancer Survivors: JACC: CardioOncology State-of-the-Art Review

Leah L Zullig et al. JACC CardioOncol. .

Abstract

There are nearly 17 million cancer survivors in the United States, including those who are currently receiving cancer therapy with curative intent and expected to be long-term survivors, as well as those with chronic cancers such as metastatic disease or chronic lymphocytic leukemia, who will receive cancer therapy for many years. Current clinical practice guidelines focus on lifestyle interventions, such as exercise and healthy eating habits, but generally do not address management strategies for clinicians or strategies to increase adherence to medications. We discuss 3 cardiometabolic comorbidities among cancer survivors and present the prevalence of comorbidities prior to a cancer diagnosis, treatment of comorbidities during cancer therapy, and management considerations of comorbidities in long-term cancer survivors or those on chronic cancer therapy. Approaches to support medication adherence and potential methods to enhance a team approach to optimize care of the individual with cancer across the continuum of disease are discussed.

Keywords: ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; CVD, cardiovascular disease; LDL-C, low-density lipoprotein cholesterol; cancer survivorship; cardiovascular comorbidities; coordination of care; medication adherence; multidisciplinary care.

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Conflict of interest statement

This work was supported by a grant from the National Cancer Institute (CA249568; MPI Drs Oeffinger and Zullig). Dr Zullig has received research funding from Proteus Digital Health and the PhRMA Foundation; and consulting fees from Novartis and Pfizer. Dr Sung has received research grants from Merck and Novartis; and research supplies from DSM and Clasado. Dr Blalock has served as a consultant for the Eating Recovery Center. Dr Bosworth has received research grants from the PhRMA Foundation, Proteus Digital Health, Otsuka, Novo Nordisk, Sanofi, and Improved Patient Outcomes; and consulting fees from Sanofi, Novartis, Otsuka, Abbott, Preventric Diagnostics, and the Medicines Company. Dr Oeffinger has served as a consultant for GRAIL. Dr Dent has received honoraria and grant funding from Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Predicting Risk in a Person-Centric Model (Lifetime Model) We present a lifetime model predicting risk in a person-centric model. Individual traits including genetic factors, lifestyle behaviors, environment, and social determinants of health impact insulin resistance, elevated blood pressure, and dyslipidemia. This impacts the development of diabetes, hypertension, and ultimate cardiovascular disease risk. This coupled with the cancer diagnosis impacts increased cardiovascular morbidity and mortality.
Figure 1
Figure 1
Medical Home for Cancer Survivors We present a medical home for cancer survivors. The cancer survivor is at the center, surrounded by their social support including caregivers and family members. The next layer is the care team including oncology, primary care, and cardiology clinical teams, among others. Each team manages care in their respective clinical area, plus shared areas including prevention of frailty, financial resources, and research opportunities, among others. This group is supported by additional professionals.
See this image and copyright information in PMC

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