Evaluation of adipocytokines and traditional cardiometabolic risk factors in young male cancer survivors: an age‐matched control study

Greenfield, David; Blewitt, Alice; Coleman, Robert E.; Walsh, Jennifer; Snowden, John A.; Ross, Richard; Han, Thang S.

doi:10.1111/cen.12869

Cited by 5 publications

(5 citation statements)

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“…Young adult survivors of childhood malignancy have an 8-fold-greater risk of cardiac mortality than the healthy population [27], and cardiovascular morbidity is one of the commonest late effects seen in cancer survivors. Cancer survivors have an increase in all the risk factors for cardiovascular disease including obesity, dyslipidaemia, insulin resistance, and type 2 diabetes [28, 29]. The increased risk particularly affects people who have had higher-intensity treatments such as haematopoietic stem cell transplantation [30].…”

Section: Discussionmentioning

confidence: 99%

Testosterone replacement in young male cancer survivors: A 6-month double-blind randomised placebo-controlled trial

et al. 2019

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BackgroundYoung male cancer survivors have lower testosterone levels, higher fat mass, and worse quality of life (QoL) than age-matched healthy controls. Low testosterone in cancer survivors can be due to orchidectomy or effects of chemotherapy and radiotherapy. We have undertaken a double-blind, placebo-controlled, 6-month trial of testosterone replacement in young male cancer survivors with borderline low testosterone (7–12 nmol/l).Methods and findingsThis was a multicentre United Kingdom study conducted in secondary care hospital outpatients. Male survivors of testicular cancer, lymphoma, and leukaemia aged 25–50 years with morning total serum testosterone 7–12 nmol/l were recruited. A total of 136 men were randomised between July 2012 and February 2015 (42.6% aged 25–37 years, 57.4% 38–50 years, 88% testicular cancer, 10% lymphoma, matched for body mass index [BMI]). Participants were randomised 1:1 to receive testosterone (Tostran 2% gel) or placebo for 26 weeks. A dose titration was performed after 2 weeks. The coprimary end points were trunk fat mass and SF36 Physical Functioning score (SF36-PF) at 26 weeks by intention to treat. At 26 weeks, testosterone treatment compared with placebo was associated with decreased trunk fat mass (−0.9 kg, 95% CI −1.6 to −0.3, p = 0.0073), decreased whole-body fat mass (−1.8 kg, 95% CI −2.9 to −0.7, p = 0.0016), and increased lean body mass (1.5 kg, 95% CI 0.9–2.1, p < 0.001). Decrease in fat mass was greatest in those with a high truncal fat mass at baseline. There was no treatment effect on SF36-PF or any other QoL scores. Testosterone treatment was well tolerated. The limitations of our study were as follows: a relatively short duration of treatment, only three cancer groups included, and no hard end point data such as cardiovascular events.ConclusionsIn young male cancer survivors with low-normal morning total serum testosterone, replacement with testosterone is associated with an improvement in body composition.Trial registrationISRCTN: 70274195, EudraCT: 2011-000677-31.

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Section: Discussionmentioning

confidence: 99%

Testosterone replacement in young male cancer survivors: A 6-month double-blind randomised placebo-controlled trial

et al. 2019

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“… 50 , 51 In cancer survivors, who are known to have increased risk of CVD, excess rates of obesity and metabolic disorders have been observed which are thought to be the consequence of late effects of chemotherapy and radiotherapy. 52 Low birthweight, a marker of poor early growth, is strikingly associated with metabolic disorders in adult life. Using the thrifty and programming hypotheses, Barker suggested that poor nutrition in utero and early life has an adverse effect on the structure and function of vital organs.…”

Section: Pathophysiologymentioning

confidence: 99%

“… 72 In individuals with type 2 diabetes whose risk for CVD is accentuated, more intensive risk factor management is warranted. In the case of cardiometabolic risk-associated drug therapy for conditions such as congenital adrenal hyperplasia 50 , 51 and cancer, 52 increased monitoring and early interventions are required to limit the long-term adverse effects of the treatment.…”

Section: Medical Managementmentioning

confidence: 99%

A clinical perspective of obesity, metabolic syndrome and cardiovascular disease

Han

Lean

2016

JRSM Cardiovascular Disease

374

285

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The metabolic syndrome is a condition characterized by a special constellation of reversible major risk factors for cardiovascular disease and type 2 diabetes. The main, diagnostic, components are reduced HDL-cholesterol, raised triglycerides, blood pressure and fasting plasma glucose, all of which are related to weight gain, specifically intra-abdominal/ectopic fat accumulation and a large waist circumference. Using internationally adopted arbitrary cut-off values for waist circumference, having metabolic syndrome doubles the risk of cardiovascular disease, but offers an effective treatment approach through weight management. Metabolic syndrome now affects 30–40% of people by age 65, driven mainly by adult weight gain, and by a genetic or epigenetic predisposition to intra-abdominal/ectopic fat accumulation related to poor intra-uterine growth. Metabolic syndrome is also promoted by a lack of subcutaneous adipose tissue, low skeletal muscle mass and anti-retroviral drugs. Reducing weight by 5–10%, by diet and exercise, with or without, anti-obesity drugs, substantially lowers all metabolic syndrome components, and risk of type 2 diabetes and cardiovascular disease. Other cardiovascular disease risk factors such as smoking should be corrected as a priority. Anti-diabetic agents which improve insulin resistance and reduce blood pressure, lipids and weight should be preferred for diabetic patients with metabolic syndrome. Bariatric surgery offers an alternative treatment for those with BMI ≥ 40 or 35–40 kg/m2 with other significant co-morbidity. The prevalence of the metabolic syndrome and cardiovascular disease is expected to rise along with the global obesity epidemic: greater emphasis should be given to effective early weight-management to reduce risk in pre-symptomatic individuals with large waists.

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“…[3][4][5][6][7][8] Causes of CV disease among cancer survivors include the effects of chemotherapy and other anticancer agents, as well as that of radiation. 9,10 Insulin resistance 11,12 and higher C-reactive protein levels 13 are associated with certain cancer treatments. The relatively high prevalence of obesity and physical inactivity during the cancer survivorship period add to the risk of developing CV disease.…”

Section: Background and Significancementioning

confidence: 99%

Oncologists' Perceptions of a Digital Tool to Improve Cancer Survivors' Cardiovascular Health

et al. 2019

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Background Cardiovascular (CV) disease continues to be a leading cause of morbidity and mortality with higher rates among cancer survivors than in the general population. Objective This study was aimed to understand oncology providers' attitudes toward a digital CV health tool, delivered via a tablet, to promote CV health in cancer survivors. Methods Using qualitative methods, 14 oncologists, from community and academic practice sites, were interviewed while they used the tool. Interviews were videotaped then analyzed using NVivo 11 software. Themes were inductively developed from the interviews. Results Three major themes emerged from the interviews as follows: (1) system functionality, (2) facilitators and barriers to integration, and (3) appropriate end-users. Oncologists recognized the critical role of CV health promotion among cancer survivors and identified features about the tool that would be helpful for CV health promotion. Workflow (subtheme) was a barrier to tool use. This feedback enabled tool redesign for further testing in the context of survivorship care. Conclusion Our findings emphasized the importance of identifying appropriate End-users which may include other survivorship care providers, patients, and primary care providers. Implications Our research addresses the knowledge gap in the use of digital tools in cancer survivorship care, specifically digital tools to promote CV health. Future research is needed to evaluate digital tools in cancer survivorship care. Research investigating patients as users of digital tools may provide additional insight.

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Evaluation of adipocytokines and traditional cardiometabolic risk factors in young male cancer survivors: an age‐matched control study

Cited by 5 publications

References 40 publications

Testosterone replacement in young male cancer survivors: A 6-month double-blind randomised placebo-controlled trial

Testosterone replacement in young male cancer survivors: A 6-month double-blind randomised placebo-controlled trial

A clinical perspective of obesity, metabolic syndrome and cardiovascular disease

Oncologists' Perceptions of a Digital Tool to Improve Cancer Survivors' Cardiovascular Health

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