Incidence and Time on Onset of Cardiovascular Risk Factors and Cardiovascular Disease in Adult Survivors of Adolescent and Young Adult Cancer and Association with Exercise

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ABSTRACT Many cancer survivors are at risk for cardiovascular complications after treatment. These complications can include cardiovascular risk factors (CVRF) such as diabetes, hypertension, dyslipidemia, and obesity and cardiovascular disease (CVD) such as heart failure, valvular heart disease, ischemic heart disease/myocardial infarction, and stroke. Those diagnosed between 15 and 20 years old are considered adolescent and young adult survivors (AYA) and frequently treated with cardiotoxic treatments which may increase their risk for CVRF and CVD. Yet little research has focused on understanding CVRF and CVD incidence in this population. An understanding of the incidence and time to onset of CVRF and CVD in this population is needed to inform surveillance and health promotion interventions. Health promotion interventions, such as exercise, may protect against the development of CVRF and CVD, because exercise has been shown to mitigate CVRF and CVD in other populations. Yet an understanding of the relationships between CVRF, CVD and exercise is unclear among this population. Utilizing data from the Childhood Cancer Survivor Study (CCSS), we will assess the incidence and time to onset of CVRF and CVD as well as relationships between CVRF, CVD and exercise for those diagnosed with cancer in the 15-to-20-year-old age group. We will identify if interventions, such as exercise, are needed for this population and if the need is increased for those who receive cardiotoxic treatments. Guided by the Cancer Survivor Research Framework, the study will address the following specific aims in 15-20 year old AYA cancer survivors: 1) Compare the incidence and time to onset of CVRF between survivors who were exposed and not exposed to cardiotoxic treatment and according to the type of cardiotoxic cancer treatments (chemotherapy, radiation, or chemo + radiation) received, 2) Compare the incidence and time to onset of CVD between survivors who were exposed and not exposed to cardiotoxic treatments and according to the type of cardiotoxic cancer treatments received, and 3) Examine longitudinal associations between self-report exercise (weekly metabolic equivalence tasks) and the incidence of CVRF and CVD in survivors across three time points (1999, 2007, and 2014). The accompanying career development plan will provide training in a) the unique needs and experiences of adult survivors of AYA cancers, b) the role exercise plays in mitigating CVRF and CVD for cancer survivors, and c) longitudinal and secondary data analyses methods. Together, the career development and research plan will support the development of an independent nurse scientist in cancer survivorship, cardiotoxicity, and exercise. This proposal will generate important knowledge related to cardiovascular complications for cancer survivors by creating risk stratification for receipt of cardiotoxic treatments. Additionally, this research will increase understanding of the effects that exercise has on CVRF and CVD, laying the foundation for future research focused on developing and testing interventions to mitigate CVRF and CVD among cancer survivors diagnosed between 15-and-20-years of age.