New research out of VCU Massey Comprehensive Cancer Center and VCU Health Pauley Heart Center indicates that survivors of childhood cancer are at a significantly higher risk of death following a major cardiovascular event — including heart failure, heart attack or stroke — than the general public.

published this week in the Journal of the American College of Cardiology

 — could fuel advocacy for a paradigm shift in clinical heart health guidelines to address cardiovascular risk factors at an earlier age in childhood cancer survivors.

“We found that the risk of death after a major cardiovascular event in a 50-year-old in the general population is equivalent to that of a 30-year-old who was previously treated for cancer as a child,” said Wendy Bottinor, M.D., lead author on the study and cardio-oncologist at Massey and the Pauley Heart Center. “Untreated risk factors have a larger impact on risk for death following a serious heart event among survivors of childhood cancer relative to the general population, and therefore we shouldn’t just assume that because someone is young they don’t need risk factors like high blood pressure or high cholesterol treated.”

Previous research has demonstrated that childhood cancer survivors have an increased risk for heart disease and a higher incidence of cardiovascular mortality compared to the general public.

This study waded deeper into the understanding of the impact of childhood cancer on survivors’ risk of death later in life following a major cardiovascular event compared to individuals who never had cancer, but also experienced one of those same heart issues.

Bottinor and her collaborators turned to a couple of robust databases for answers, including the Childhood Cancer Survivors Study, which includes a large cohort of 25,000 survivors of childhood cancer and their siblings, and the CARDIA study, which is a racially diverse cardiology database of young adults created to gain insights on how people develop heart disease.

They found that following heart failure, heart attack or stroke, mortality was higher in childhood cancer survivors than in their siblings who did not have cancer. Strikingly, compared with the general population, survivors of childhood cancer were more than a decade younger when they experienced one of those three events.

“This study supports the concept that survivors of childhood cancer experience what appears like accelerated aging, where their overall medical profiles are similar to people who are 10 or more years older,” said Bottinor, who is also a member of the Cancer Prevention and Control research program at Massey.

In an effort to identify some potential solutions, the researchers determined that a medical condition known as dyslipidemia — an imbalance of cholesterol or fat in the blood that can lead to clogged arteries and serious heart issues — correlated to lower mortality following a cardiovascular event. People who are diagnosed with dyslipidemia are commonly prescribed statins, drugs that reduce risk of heart complications by lowering cholesterol levels and mitigating chronic inflammation, a known risk factor for both heart disease and cancer. Previous evidence suggests statins may be heart-protective medications in patients undergoing cancer treatment.

This led Bottinor and her collaborators to suggest that using statins more universally in childhood cancer survivors, instead of only in the population that presents with heart problems, could provide general and increased protection against mortality following a cardiovascular complication later in life.

Additionally, this paper indicates that hypertension — elevated blood pressure — was also associated with an increased risk for heart-related death in childhood cancer survivors. Previous published data demonstrates that if someone who was treated for cancer is hypertensive, their risk for heart disease is magnified compared to someone who is hypertensive but has never been treated for cancer.

Bottinor said that current guidelines from multiple medical associations often include high thresholds regarding who is eligible to receive blood pressure medication, particularly for younger patients, and that these parameters should be adjusted to reduce the risk of long-term heart complications.

“We probably should be lowering that bar for treating hypertension when we’re talking about survivors of childhood cancer because their risk for heart disease is so much higher than the general population,” Bottinor said.

Looking ahead, Bottinor said further research needs to be conducted to better understand the burden of heart health risk factors in younger adults who have been treated for cancer; clinical trials need to be activated that investigate if risk factor modification impacts patient outcomes; and efforts need to be implemented to increase general awareness of the risk factors that result following cancer treatment in children and younger adults.

The emerging field of cardio-oncology is paving the way for expert, multidisciplinary heart care before, during and after cancer treatment to mitigate adverse effects on cardiovascular health. The cardio-oncology program at Massey and the Pauley Heart Center is the only program in Virginia that has been accredited by

the International Cardio-Oncology Society as a Center of Excellence

Collaborators on Bottinor’s research include Eric Chow M.D., M.P.H., and David Doody, M.S., of Fred Hutchinson Cancer Center; Cindy Im, Ph.D., and David Jacobs, Jr., Ph.D., of the University of Minnesota; Saro Armenian, D.O., M.P.H., of City of Hope; Alexander Arynchyn, M.D., Ph.D., of the University of Alabama; Borah Hong, M.D., of Seattle Children’s Hospital; Rebecca Howell, Ph.D., of MD Anderson Cancer Center; Gregory Armstrong, M.D., Kirsten Ness, Ph.D., and Yutaka Yasui, Ph.D., of St. Jude’s Children’s Research Hospital; Kevin Oeffinger, M.D., of Duke University; and Alexander Reiner, M.D., M.Sc., of the University of Washington.

This study was funded by the National Cancer Institute (CA55727, CA204378, R21 CA261833), St. Jude’s Children’s Research Hospital (CA21765), the American Lebanese-Syrian Associated Charities, The Tomorrow Fund (636214), the American Heart Association (19CDA34760181), the National Center for Advancing Translational Sciences (KL2TR002648), the Children’s Cancer Research Fund, and the University of Minnesota Pediatric Foundation.

Articles

Survivors of childhood cancer are at a significantly higher risk of death following a major cardiovascular event than the general public.

Long-Term Survivors of Childhood Cancer at Higher Risk of Death Following Heart Issues; Threshold for Treating Risk Factors Should Be Lower

Three Virginia health systems together will serve as one of eight groups in the U.S. to conduct groundbreaking research for the Cancer Screening Research Network (CSRN), launched this week by the National Cancer Institute (NCI), part of the National Institutes of Health. The new clinical trials network creates a national infrastructure to study emerging cancer screening and prevention technologies, with the goal of reducing cancer-related illnesses and deaths in support of the Biden-Harris Administration’s Cancer Moonshot initiative.

The CSRN will amplify efforts to evaluate the benefits and harms of promising new technologies for cancer screening and to identify effective strategies to incorporate these technologies into the standard of care.

As part of this national network, the Virginia CSRN Accrual, Enrollment and Screening Site (ACCESS) Hub will be a partnership between the VCU Massey Comprehensive Cancer Center and the C. Kenneth and Dianne Wright Center for Clinical and Translational Research with VCU Health; the Inova Schar Cancer Institute and its Saville Cancer Screening and Prevention Center; and Sentara Health, the Sentara Health Research Center and academic partner Eastern Virginia Medical School (EVMS).

This statewide partnership will leverage its health systems’ large geographic footprints across Virginia — as well as their established track record of community trust-building and equitable, inclusive clinical trial recruitment — to engage trial participants who represent the commonwealth’s diverse population.

“The evidence gathered through this network could inform national guidelines and screening practices for generations to come, and ultimately, improve health outcomes for all Americans, especially our most underserved communities,” said Alex Krist, MD, MPH, professor of family medicine and population health at VCU School of Medicine and member of the Cancer Prevention and Control research program at Massey.

The co-principal investigators for the Virginia CSRN ACCESS Hub include Krist, who is also the former chair of the U.S. Preventive Services Task Force; Patrick Nana-Sinkam, MD, chair and professor of Pulmonary Disease and Critical Care Medicine at VCU and the Linda Grandis Blatt Endowed Chair in Cancer Research at Massey; and Rebecca Kaltman, M.D., executive director at Inova Saville Cancer Screening and Prevention Center. Anita Harrison, MPA, executive director for research strategy at Massey, led the grant proposal development.

“We are in dire need of new tools to detect more types of cancer at earlier, more treatable stages,” Kaltman said. “We are thrilled to be part of the NCI’s effort to bring the promise of novel techniques for cancer screening to the people of Virginia through this important collaboration.”

The Virginia partnership represents an interdisciplinary team of experts with primary care, oncology, preventive services and community engagement backgrounds. The collaboration will benefit from the resources and engage the patient populations of three large health systems, two medical schools, three cancer centers, the Wright Center for Clinical and Translational Research and a statewide, primary care practice-based research network.

“We at Massey and VCU, along with our esteemed colleagues at Sentara, Inova and EVMS, will work hard to ensure that historically marginalized and underserved communities, both rural and urban, have equal access to cutting-edge research opportunities through this CSRN effort,” said Robert A. Winn, MD, director and Lipman Chair in Oncology at Massey. “It’s an honor to bring our expertise in closing those gaps in screening and care to help advance this important work on a national scale.”

Evaluating multi-cancer detection tests — simple blood tests that screen for multiple types of cancers simultaneously — is a primary aim of the Cancer Moonshot, a federal initiative with the ambitious goal of cutting cancer deaths in half by 2047. 

In 2024, the CSRN will launch a four-year pilot study, called the Vanguard Study on Multi-Cancer Detection, that will enroll up to 24,000 people ages 45 to 70 to inform the design of a much larger randomized controlled trial involving about 225,000 people to evaluate the benefits and harms of these multi-cancer detection tests. The Virginia CSRN ACCESS Hub will be responsible for enrolling a portion of the participants for the Vanguard study, which will investigate the effectiveness of two MCDs compared to standard cancer screening care and evaluate whether primary care settings can feasibly incorporate them into their routine practice.

“Clinically informative blood-based testing for several cancers has eluded researchers and clinicians for years,” said Nana-Sinkam. “We now have the opportunity to make a significant advancement in cancer detection for all.”

John Sayles, MD, site principal investigator on the upcoming Vanguard study and Sentara colon and rectal surgeon, said that early detection is paramount for improving cancer care and cure.

“Being part of the Virginia CSRN ACCESS Hub will allow important research to include all eligible patients, especially those historically underrepresented,” Sayles said. “Sentara Health and the Sentara Brock Cancer Center are excited to be a large part of this cutting-edge research, aimed to accelerate medical breakthroughs in an equitable and inclusive manner.”

For more information about the Virginia CSRN, visit 

Three Virginia health systems together will serve as one of eight groups in the U.S. to conduct research for the Cancer Screening Research Network.

Virginia Health Systems Partner as Part of New NIH Research Network Evaluating Emerging Cancer Screening Technologies

VCU Massey Cancer Center has been designated a Comprehensive Cancer Center by the National Cancer Institute (NCI), the nation’s principal authority on cancer research and training. Massey’s receipt of the highest level of recognition from the NCI places it among an elite group of cancer centers influencing a new standard of care through research, education and community engagement.

Massey’s director, Robert A. Winn, MD, is the first African American to lead a cancer center to comprehensive status. Under Winn’s leadership, Massey has effectively championed a community-centered approach, recognizing community members as equal experts and strategic partners in its research efforts.

“We are so proud to reach this milestone, and to be leading the charge not just in research but in building trust and breaking down barriers between medical institutions and communities,” said Winn, who also holds the Lipman Chair in Oncology at Massey. “We are truly the first of a new generation of community-focused cancer centers, where world-class science and research is informed by the people we serve, and accessible for all.”

Since beginning his tenure as director of Massey in December 2019, Winn has focused on taking Massey’s mission into the 66 contiguous localities in central, eastern and southern Virginia comprising Massey’s catchment area. With the community’s involvement, Massey has successfully increased 

 enrollment, expanded its transdisciplinary research collaboration and strengthened its cancer research training activities.

The NCI commended Massey for its significant strengths in the full spectrum of cancer research, robust pathway for cancer research training and education and plans to further enhance the diversity of its trainees and faculty.

The renewal of its Cancer Center Support Grant (CCSG) provides Massey with funding for its cancer research programs over five years and makes the cancer center eligible for additional information-sharing and resources reserved for the top institutions that demonstrate superior research capabilities.

VCU Massey Cancer Center has been designated a Comprehensive Cancer Center by the National Cancer Institute, the nation’s principal authority on cancer research and training. 

VCU Massey Cancer Center

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Long-Term Survivors of Childhood Cancer at Higher Risk of Death Following Heart Issues; Threshold for Treating Risk Factors Should Be Lower

Virginia Health Systems Partner as Part of New NIH Research Network Evaluating Emerging Cancer Screening Technologies

VCU Massey Cancer Center Achieves Comprehensive Status From the National Cancer Institute