Survivorship Symposium 2017: Younger Survivors of Thyroid Cancer Face Increased Risk of Hypertension, Heart Disease, and Osteoporosis

Key Points

  • Survivors of thyroid cancer ages 40 years and younger were five times more likely to develop swelling around the heart; more than twice as likely to develop heart valve disease; and seven times more likely to develop osteoporosis than older people without a history of cancer.
  • Many survivors of thyroid cancer are treated successfully and live many years after their cancer diagnosis.
  • Since thyroid cancer affects a young population, understanding the late effects resulting from thyroid cancer treatment, especially cardiac and osteoporosis risks, may lead to better surveillance and disease management of younger survivors.

According to the American Cancer Society, in the United States, thyroid cancer is the most rapidly increasing cancer, tripling in the past 3 decades, and is commonly diagnosed at a younger age than most other adult cancers. A study by Blackburn et al examining whether survivors of thyroid cancer ages 40 and younger experience greater risks of late effects from their treatment than older cancer-free people for diseases associated with aging found that the cancer survivors were five times more likely to develop swelling around the heart; more than twice as likely to develop heart valve disease; and seven times more likely to develop osteoporosis than the control group. Understanding the late effects resulting from treatment may lead to better surveillance and disease management of younger survivors, according to the study findings. The study will be presented at the 2017 Cancer Survivorship Symposium.

Study Methodology

The researchers matched up five cancer-free individuals with each thyroid cancer survivor based on birth year, sex, birth state, and follow-up time from case diagnosis date within the Utah Population Database. Electronic medical records, statewide ambulatory surgery, and inpatient discharge data were used to identify late effects stratified over three time periods: 1 to 5 years, 5 to 10 years, and over 10 years after cancer diagnosis.

Cox proportional hazards models were used to estimate hazard ratios (HR), with adjustment on matching factors, race, body mass index at diagnosis, and Charlson Comorbidity Index at diagnosis.

Study Findings

The researchers analyzed data on 4,060 thyroid cancer survivors and 18,557 matched cancer-free individuals (1,407 cases diagnosed ages < 40 years, 2,076 cases diagnosed ages 40–65 years). They found that the risk for hypertension was significantly increased in both younger (HR = 1.54, 95% CI = 1.18–2.01) and older patients (HR = 1.30, 95% CI = 1.11–1.53) > 10 years after cancer diagnosis. For heart disease, increased risks persisted for the young patients > 10 years after cancer diagnosis for heart valve disorders (HR = 2.43, 95% CI = 1.36–4.33) and for peri-, endo- or myocarditis (HR = 5.12, 95%CI = 1.04–25.14), whereas corresponding hazard ratios for the older age group did not suggest increased risks. For osteoporosis, the younger patients had a higher risk (HR = 8.77, 95% CI = 3.18–24.18) than the older population (HR = 2.55, 95% CI = 2.07–3.13) 1 to 5 years after cancer diagnosis.

Understanding Late Effects From Treatment

“This is a population that is living a long time after a thyroid cancer diagnosis, so understanding late effects can lead to better surveillance and disease management,” said Brenna Blackburn, MPH, lead author of the study and a member of the Hashibe Lab at Huntsman Cancer Institute at the University of Utah, during a press briefing on her study results.

“The reality is that many patients with thyroid cancer are treated successfully and do live very long lives after cancer and cancer treatment,” said Merry Jennifer Markham, MD, ASCO expert and moderator of the press briefing. “But we still don’t know enough about how treatment affects these patients later in life. This study helps to underscore the need for personal and survivorship care, and it highlights the areas to focus on in these patients, particularly the cardiac risk and the risk of osteoporosis.”

 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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