Cardiovascular disease-related chronic conditions among Veterans Affairs nonmetastatic colorectal cancer survivors: a matched case–control analysis
Received 16 October 2018
Accepted for publication 29 May 2019
Published 22 July 2019 Volume 2019:11 Pages 6793—6802
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Rituraj Purohit
Leah L Zullig,1,2 Valerie A Smith,1,2 Jennifer H Lindquist,1 Christina D Williams,3,4 Morris Weinberger,1,5 Dawn Provenzale,1,4 George L Jackson,1,2 Michael J Kelley,6–8 Susanne Danus,1 Hayden B Bosworth1,2,9
1Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA; 2Department of Population Health Sciences, Duke University, Durham, NC, USA; 3Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA; 4Cooperative Studies Program Epidemiology Center, Durham, NC, USA; 5Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA; 6Office of Specialty Care Services, Department of Veterans Affairs, Washington, DC, USA; 7Hematology-Oncology Service, Durham Veterans Affairs Medical Center, Durham, NC, USA; 8Department of Medicine, Duke University, Durham, NC, USA; 9Departments of Psychiatry and School of Nursing, Duke University, Durham, NC, USA
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
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