Cardiovascular disease-related chronic conditions among Veterans Affairs nonmetastatic colorectal cancer survivors: a matched case–control analysis

Abstract

Purpose

The growing number of colorectal cancer (CRC) survivors often have multiple chronic conditions. Comparing nonmetastatic CRC survivors and matched noncancer controls, our objectives were to determine the odds of CRC survivors being diagnosed with cardiovascular disease (CVD)-related chronic conditions and their likelihood of control during the year after CRC diagnosis.

Patients and methods

We retrospectively identified patients diagnosed with nonmetastatic CRC in the Veterans Affairs health care system from fiscal years 2009 to 2012 and matched each with up to 3 noncancer control patients. We used logistic regression to assess differences in the likelihood of being diagnosed with CVD-related chronic conditions and control between nonmetastatic CRC survivors and noncancer controls.

Results

We identified 9,758 nonmetastatic CRC patients and matched them to 29,066 noncancer controls. At baseline, 69.4% of CRC survivors and their matched controls were diagnosed with hypertension, 52.4% with hyperlipidemia, and 36.7% with diabetes. Compared to matched noncancer controls, CRC survivors had 57% higher odds of being diagnosed with hypertension (OR=1.57, 95% CI=1.49–1.64) and 7% higher odds of controlled blood pressure (OR=1.07, 95% CI 1.02, 1.13) in the subsequent year. Compared to matched noncancer control patients, CRC survivors had half the odds of being diagnosed with hyperlipidemia (OR=0.50, 95% CI=0.48–0.52) and lower odds of low-density lipoprotein (LDL) control (OR 0.88, 95% CI 0.81–0.94). There were no significant differences between groups for diabetes diagnoses or control.

Conclusion

Compared to noncancer controls, nonmetastatic CRC survivors have 1) greater likelihood of being diagnosed with hypertension and worse blood pressure control in the year following diagnosis; 2) lower likelihood of being diagnosed with hyperlipidemia or LDL control; and 3) comparable diabetes diagnoses and control. There may be a need for hypertension control interventions targeting cancer survivors.

Keywords:

• Veterans Affairs
• colorectal neoplasms
• cancer survivors
• cardiovascular disease
• comorbidity
• chronic disease management

Acknowledgments

We thank the Veterans Affairs cancer registrars and VA Central Cancer Registry staff for their data collection and related efforts. This study is supported by a VA Health Services Research and Development (HSR&D) Career Development Award (CDA 13-025) awarded to Dr Leah L Zullig. This study is also supported by a Veterans Affairs Health Services Research and Development Senior Career Scientist Award (HSRD 08-027) awarded to Dr Hayden B Bosworth. This work was supported by the Center of Innovation for Health Services Research in Primary Care (CIN 13-410) at the Durham VA Health Care System. This work was previously presented at the American Society of Medical Oncology (ASCO) Cancer Survivorship Symposium in March 2018; the abstract was published in a supplemental issue of the Journal of Clinical Oncology.

Disclosure

Dr Leah L Zullig reports grants from Department of Veterans Affairs, during the conduct of the study. Dr George L Jackson reports grants from Department of Veterans Affairs, during the conduct of the study and grants from Bristol-Myers Squibb Foundation, outside of the submitted work. Dr Hayden B Bosworth reports grants from Johnson & Johnson, Improve Patient Outcomes, Cover MyMeds, and Omnicell. He also received grants and personal fees from Otsuka and Sanofi, outside of the submitted work. The authors report no other conflicts of interest in this work.