The University of North Carolina at Chapel Hill, Chapel Hill, NC
Kevin A. Pearlstein , Laura H. Hendrix , Ronald C. Chen
Background: CVD is a major cause of mortality in cancer survivors. Prior claims-based studies suggested underutilization of preventive care in cancer survivors, but most CVD preventive care items are not available in claims data. We directly examined the prevalence of CVD risk factors and receipt of care in survivors compared to the non-cancer general population (control) using the National Health Interview Survey. Methods: 32,934 cancer survivors interviewed between 1999 and 2011 were matched to 65819 controls based on age, race, and history of CVD events (angina, myocardial infarction, stroke). Statistical analysis accounted for population sampling weight. Results: CVD risk factors were prevalent among cancer survivors (Table), and 33% continued to smoke. Primary care visits were reported more often among survivors compared to controls (83% vs 74%, p<0.001). A high proportion of survivors and controls received monitoring for diagnosed CVD risk factors, while rates of interventions to modify the risk factors were more modest. On multivariable logistic regression models, having a general doctor visit was associated with increased monitoring for all CVD risk factors examined (hypertension, hyperlipidemia, diabetes, obesity, smoking),but there was no significant difference between cancer vs control. Conclusions: Cancer survivors in the US receive comparable monitoring and interventions for CVD risk factors compared to non-cancer individuals. Survivorship care involving a general doctor was associated with improved monitoring of CVD risk factors.
Prevalence | Monitoring in individuals with risk factor |
Intervention in individuals with risk factor |
|||||||
---|---|---|---|---|---|---|---|---|---|
Risk factor | Cancer survivor | Definition | Cancer | Control | P | Definition | Cancer | Control | P |
Hypertension | 49% | Blood pressure check in past year |
96% | 93% | <.01 | Instructed to modify lifestyle | 75% | 75% | .79 |
Prescribed medication | 89% | 88% | .42 | ||||||
Taking medication | 91% | 92% | .44 | ||||||
Diabetes | 14% | Glucose check in past 3 years |
85% | 86% | .29 | Taking oral hypoglycemic | 48% | 49% | .14 |
Taking insulin | 19% | 20% | .47 | ||||||
Hyperlipidemia | 41% | Cholesterol check in past year | 91% | 89% | .05 | - | - | - | - |
Obesity | 30% | - | - | - | - | Exercise in past month | 44% | 41% | <.01 |
Smoking | 33% | - | - | - | - | Smoking cessation attempt in past year |
45% | 41% | <.01 |
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