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Open Access Article

Looking Beyond Recurrence: Comorbidities in Cancer Survivors

Amy Edgington
Mary Ann Morgan
CJON 2011, 15(1), E3-E12 DOI: 10.1188/11.CJON.E3-E12

Cancer recurrence is a very real concern for cancer survivors. Surveillance for recurrence and vigilance for development of new cancers are top priorities during follow-up visits after active treatment ends. However, the cancer survivor also is at risk for the development of comorbid conditions. These conditions, including obesity, diabetes, dyslipidemia, menopause, decreased bone mass, hypertension, and hypothyroidism, are discussed with their relevance for general health and their relationships to disease-specific cancers. All of these conditions should be routinely addressed as part of the patient's survivorship care when appropriate. The oncology nurse is in a prime position to educate survivors about the risks for these conditions, both through evidence-based practice guidelines specific to each condition and also through the use of a treatment summary and care plan. This article discusses these selected comorbidities and offers strategies for nurses to address them with survivors during follow-up visits. Clinical practice guidelines for comorbidities are included, along with oncology implications and relevance for survivors. Recommendations for modifiable risk factors and healthy living also are included, along with Web sites for survivorship care plans.

References 

Albini, A., Pennesi, G., Donatelli, F., Cammarota, R., De Flora, S., & Noonan, DM. (2010). Cardiotoxicity of anticancer drugs: The need for cardio-oncology and cardio-oncological prevention. <i>Journal of the National Cancer Institute, 102</i>, 14-25.

Alexander, I. (2009). Pharmacotherapeutic management of osteoporosis and osteopenia. <i>Nurse Practitioner, 34</i>(6), 30-40.

American Association of Clinical Endocrinologists. (2002). Thyroid Task Force. Medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. <i>Endocrine Practice, 8</i>, 457-469.

American Association of Clinical Endocrinologists. (2006). Menopause Guidelines Revision Task Force. Medical guidelines for the clinical practice for the diagnosis and treatment of menopause. <i>Endocrine Practice, 12</i>, 315-337.

American Association of Clinical Endocrinologists. (2007). Diabetes Mellitus Clinical Practice Guidelines Task Force. <i>Medical guidelines for clinical practice for the management of diabetes mellitus.</i> Retrieved from <a target="_blank" href='http://www.aace.com/pub/pdf/guidelines/DMGuidelines2007.pdf'>http://www....

American Association of Clinical Endocrinologists. (2009). <i>Statement by an American Association of Clinical Endocrinologists Consensus Panel on type 2 diabetes: An algorithm for glycemic control.</i> Retrieved from <a target="_blank" href='http://www.aace.com/pub/pdf/GlycemicControlAlgorithm.pdf'>http://www.aac...

American Cancer Society. (2010). <i>American Cancer Society guidelines on diet and cancer prevention.</i> Retrieved from <a target="_blank" href='http://www.cancer.org/docroot/MED/content/MED_2_1X_American_Cancer_Socie...

American Diabetes Association. (2010a). <i>Diabetes basics: Type 2.</i> Retrieved from <a target="_blank" href='http://www.diabetes.org/diabetes-basics/type-2'>http://www.diabetes.org/...

American Diabetes Association. (2010b). Diagnosis and classification of diabetes mellitus. <i>Diabetes Care, 33</i>(Suppl. 1), 562-569.

American Diabetes Association. (2010c). Executive summary: Standards of medical care in diabetes-2010. <i>Diabetes Care, 33</i>(Suppl. 1), S4-S10. doi: 10.2337/dc10-S004

Andriole, G. L. (2009). The impact of prostate cancer and hormonal therapy on bone. <i>Reviews in Urology, 11</i>(4), 185-189.

Ballard-Barbash, R., & Swanson, C. (1996). Body weight: Estimation of risk for breast and endometrial cancer. <i>American Journal of Clinical Nutrition, 63</i>(3, Suppl.), 437S-441S.

Bethge, W., Guggenberger, D., Bamberg, M., Kanz, L., & Bokemeyer, C. (2000). Thyroid toxicity of treatment for Hodgkin disease. <i>Annals of Hematology, 79</i>, 114-118.

Black, D. M., Delmas, P. D., Eastell, R., Reid, I. R., Boonen, S., Cauley, J. A.,… HORIZON Pivotal Fracture Trial. (2007). Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. <i>New England Journal of Medicine, 356</i>, 1809-1822.

Boekhout, A. H., Beijnen, J., & Schellens, J. (2006). Symptoms and treatment in cancer therapy-induced early menopause. <i>Oncologist, 11</i>, 641-654. doi: 10.1634/theoncologist.11-6-641

Bray, G. (2010). <i>Screening for and clinical evaluation of obesity in adults.</i> Retrieved from <a target="_blank" href='http://www.uptodate.com/online/content/topic.do?topicKey=obesity/4467&vi...

Centers for Disease Control and Prevention. (2007). <i>CDC national diabetes fact sheet.</i> Retrieved from <a target="_blank" href='http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf'>http://www.cdc.gov/d...

Centers for Disease Control and Prevention. (2009). <i>Cholesterol fact sheet.</i> Retrieved from <a target="_blank" href='http://www.cdc.gov/dhdsp/library/fs_cholesterol.htm'>http://www.cdc.gov/...

Centers for Disease Control and Prevention. (2010a). <i>National health and nutrition examination survey data.</i> Retrieved from <a target="_blank" href='http://www.cdc.gov/nchs/nhanes.htm'>http://www.cdc.gov/nchs/nhanes.htm</a>

Centers for Disease Control and Prevention. (2010b). <i>Overweight and obesity.</i> Retrieved from <a target="_blank" href='http://www.cdc.gov/obesity/index.html'>http://www.cdc.gov/obesity/index....

Coleman, R. E., Banks, L. M., Girgis, S. I., Kilburn, L. S., Vrdoljak, E., Fox, J.,… Intergroup Exemestane Study Group. (2007). Skeletal effects of exemestane on bone-mineral density, bone biomarkers, and fracture incidence in post-menopausal women with early breast cancer participating in the Intergroup Exemestane Study (IES): A randomized controlled study. <i>Lancet Oncology, 8</i>, 119-127. doi: 10.1016/S1470-2045(07)70003-7

Daniels, J. (2006). Obesity: America's epidemic. <i>American Journal of Nursing, 106</i>, 40-49.

Darby, S. C., Cutter, D. J., Boerma, M., Constine, L. S., Fajardo, L. F., Kodama, K.,… Shore, R. E. (2010). Radiation-related heart disease: Current knowledge and future prospects. <i>International Journal of Radiation Oncology, Biology, Physics, 76</i>, 656-665. doi: 10.1016/j.ijrobp.2009.09.064

Domino, F., & Kaplan, N. (2009). <i>Overview of hypertension in adults.</i> Retrieved from <a target="_blank" href='http://www.utdol.com/online/content/topic.do?topicKey=hyperten/23203&sel...

Earle, C. (2006). Failing to plan is planning to fail: Improving the quality of care with survivorship care plans. <i>Journal of Clinical Oncology, 24</i>, 5112-5116.

Flegal, K., Carroll, M., Ogden, C., & Curtin, L. (2010). Prevalence and trends in obesity among U. S. adults, 1999-2008. <i>JAMA, 303</i>, 235-241. doi: 10.1001/jama.2009.2014

Funnell, M. M., Brown, T. L., Childs, B. P., Haas, L. B., Hosey, G. M., Jensen, B.,… Weiss, M. A. (2010). National standards for diabetes self-management education. <i>Diabetes Care, 33</i>(1, Suppl.), S89-S98. doi: 10.2337/dc10-S089

Ganz, P. (2005). Breast cancer, menopause, and long-term survivorship: Critical issues for the 21st century. <i>American Journal of Medicine, 118</i>(12B), 136S-141S. doi: 10.1016/j.amjmed.2005.09.047

Ganz, P. (2006). Monitoring the physical health of cancer survivors: A survivorship-focused medical history. <i>Journal of Clinical Oncology, 24</i>, 5105-5111.

Ganz, P. (2009). Survivorship: Adult cancer survivors. <i>Primary Care Clinical Office Practice, 36</i>, 721-741. doi: 10.1016/j.pop.2009.08.001

Gibaldi, M. (2005). Bioequivalence of thyroid preparations: The final word? <i>American Association of Pharmaceutical Scientists, 7</i>, E59-E60. doi: 10.1208/aapsj070108

Gnant, M. F., Mlineritsch, B., Luschin-Ebengreuth, G., Grampp, S., Kaessmann, H., Schmid, M.,… Austrian Breast and Colorectal Cancer Study Group. (2007). Zoledronic acid prevents cancer treatment-induced bone loss in premenopausal women receiving adjuvant endocrine therapy for hormone-responsive breast cancer: A report from the Austrian Breast and Colorectal Cancer Study Group. <i>Journal of Clinical Oncology, 25</i>, 820-828.

Goodwin, P. (2009). <i>Vitamin D in cancer patients: Above all, do no harm.</i> Retrieved from <a target="_blank" href='http://jco.ascopubs.org/cgi/content/full/27/13/2117'>http://jco.ascopubs...

Grundy, S. (2004). Obesity, metabolic syndrome, and cardiovascular disease. <i>Journal of Clinical Endocrinology and Metabolism, 89</i>, 2595-2600.

Hewitt, M., Greenfield, S., & Stovall, E. (2006). <i>From cancer patient to cancer survivor: Lost in transition.</i> Washington, DC: National Academies Press.

Hewitt, M., Rowland, J., & Yancik, R. (2003). Cancer survivors in the United States: Age, health, and disability. <i>Journal of Gerontology, 58</i>, 82-91.

Hu, F. B., Manson, J. E., Liu, S., Hunter, D., Colditz, G. A., Michels, K. B.,… Giovannucci, E. (1999). Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women. <i>Journal of the National Cancer Institute, 91</i>, 542-547. doi: 10.1093/jnci/91.6.542

Izzedine, H., Ederhy, S., Goldwasser, F., Soria, J. C., Milano, G., Cohen, A.,… Spano, J. P. (2009). Management of hypertension in angiogenesis inhibitor-treated patients. <i>Annals of Oncology, 20</i>, 807-815. doi: 10.1093/annonc/mdn713

Jain, M., & Townsend, R. (2007). Chemotherapy agents and hypertension: A focus on angiogenesis blockage. <i>Current Hypertension Reports, 9</i>, 320-328.

Katzung, B. G. (2004). <i>Basic and clinical pharmacology.</i> New York, NY: Lange Medical Books/McGraw Hill.

Loprinzi, C. L., Kugler, J. W., Sloan, J. A., Mailliard, J. A., LaVasseur, B. I., Barton, D. L.,… Christensen, B. J. (2000). Venlafaxine in management of hot flashes in survivors of breast cancer: A randomized controlled trial. <i>Lancet, 356</i>, 2059-2063. doi: 10.1016/S0140-6736(00)03403-6

Ma, G., Sabin, N., & Dawes, M. (2008). A comparison of blood pressure measurement over a sleeved arm versus a bare arm. <i>Canadian Medical Association Journal, 178</i>, 585-589.

Meredith, P., & Horan, N. (2000). <i>Adult primary care.</i> Philadelphia, PA: W. B. Saunders.

Merriam-Webster. (n.d.). <i>Comorbid.</i> Retrieved from <a target="_blank" href='http://dictionary.reference.com/browse/comorbid'>http://dictionary.refer...

Miller, M., & Agrawal, A. (2009). Hypothyroidism in postradiation head and neck cancer patients: Incidence, complications, and management. <i>Current Opinion in Otolaryngology and Head and Neck Surgery, 17</i>, 111-115. doi: 10.1097/MOO.0b013e328325a538

Mosher, C. E., Sloane, R., Morey, M. C., Clutter Snyder, D., Cohen, H. J., Miller, P. E., & Demark-Wahnefried, W. (2009). Associations between lifestyle factors and quality of life among older long term breast, prostate, and colorectal cancer survivors. <i>Cancer, 115</i>, 4001-4009. doi: 10.1002/cncr.24436

Mullan, F. (1985). Seasons of survival: Reflections of a physician with cancer. <i>New England Journal of Medicine, 313</i>, 270-273.

National Cholesterol Education Program. (2002). <i>Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III).</i> Retrieved from <a target="_blank" href='http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm'>http://www...

National Coalition for Cancer Survivorship. (2009). <i>National Coalition for Cancer Survivorship: The organization.</i> Retrieved from <a target="_blank" href='http://www.canceradvocacy.org/about/org'>http://www.canceradvocacy.org/a...

National Comprehensive Cancer Network. (2010). <i>Clinical Practice Guidelines in Oncology™: Cancer-related fatigue.</i> Retrieved from <a target="_blank" href='http://www.nccn.org/professionals/physician_gls/PDF/fatigue.pdf'>http://...

National Heart, Lung, and Blood Institute. (2010a). <i>The practical guide: Identification, evaluation, and treatment of overweight adults.</i> Retrieved from <a target="_blank" href='http://www.nhlbi.nih.gov/guidelines/obesity/practgde.htm'>http://www.nhl...

National Heart, Lung, and Blood Institute. (2010b). <i>The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7).</i> Retrieved from <a target="_blank" href='http://www.nhlbi.nih.gov/guidelines/hypertension/index.htm'>http://www.n...

National Institutes of Health. (2000). <i>The practical guide, identification, evaluation, and treatment of overweight and obesity in adults.</i> Retrieved from <a target="_blank" href='http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf'>http://www.nhl...

National Institutes of Health Office of Dietary Supplements. (2009). <i>Dietary supplement fact sheet: Calcium.</i> Retrieved from <a target="_blank" href='http://ods.od.nih.gov/factsheets/calcium.asp'>http://ods.od.nih.gov/fact...

National Osteoporosis Foundation. (2008). <i>Clinician's guide to prevention and treatment of osteoporosis.</i> Retrieved from <a target="_blank" href='http://www.nof.org/professionals/Clinicians_Guide.htm'>http://www.nof.or...

Norman, A., Bouillon, R., Whiting, S., Vieth, R., & Lips, P. (2007). 13th workshop consensus for vitamin D nutritional guidelines. <i>Journal of Steroid Biochemistry and Molecular Biology, 103</i>, 204-205. doi: 10.1016/j.jsbmb.2006.12.071

North American Menopause Society. (2010). Position statement: Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American Menopause Society. <i>Menopause, 17</i>, 242-255.

Oyer, D., Shah, A., & Bettenhausen, S. (2006). How to manage steroid diabetes in the patient with cancer. <i>Supportive Oncology, 4</i>, 479-483.

Pandya, K. J., Morrow, G. R., Roscoe, J. A., Zhao, H., Hickok, J. T., Pajon, E.,… Flynn, P. J. (2005). Gabapentin for hot flashes in 420 women with breast cancer: A randomized double-blind placebo-controlled trial. <i>Lancet, 366</i>, 818-824. doi: 10.1016/S0140-6736(05)67215-7

Rizzo, J. D., Wingard, J. R., Tichelli, A., Lee, S. J., Van Lint, M. T., Burns, L. J.,… Socié, G. (2006). Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation: Joint recommendations of the European Group for Blood and Marrow Transplantation, the Center for International Blood and Marrow Transplant Research, and the American Society of Blood and Marrow Transplantation. <i>Biology of Blood and Marrow Transplantation, 12</i>, 138-151.

Saylor, P., Keating, N., & Smith, M. (2009). Prostate cancer survivorship: Prevention and treatment of the adverse effects of androgen deprivation therapy. <i>Journal of General Internal Medicine, 24</i>(Suppl. 2), 389-394. doi: 10.1007/s11606-009-0968-y

Smith, G. L., Smith, B. D., Garden, A. S., Rosenthal, D. I., Sherman, S. I., Morrison, W. H.,… Buchholz, T. A. (2009). Hypothyroidism in older patients with head and neck cancer after treatment with radiation: A population-based study. <i>Head and Neck, 31</i>, 1031-1038. doi: 10.1002/hed.21066

Smith, M. R. (2008). Treatment-related diabetes and cardiovascular disease in prostate cancer survivors. <i>Annals of Oncology, 19</i>, vii86-vii90. doi: 10.1093/annonc/mdn458

Stein, E., Ebeling, P., & Shane, E. (2007). Post-transplantation osteoporosis. <i>Endocrinology and Metabolism Clinics of North America, 36</i>, 937-963. doi: 10.1016/j.ecl.2007.07.008

Turnbull, F., Neal, B., Ninomiya, T., Algert, C., Arima, H., Barzi, F.,… MacMahon, S. (2008). Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: Meta-analysis of randomized trials. <i>BMJ, 336</i>, 1121-1123. doi: 10.1136/bmj.39548.738368.BE

UpToDate. (2010). <i>Metformin: Drug information.</i> Retrieved from <a target="_blank" href='http://www.uptodate.com/online/contnet/topic.do?topicKey=drug_1_z/159390...

Utian, W. H. (2004). Menopause-related definitions. <i>International Congress Series, 1266</i>, 133-138. doi: 10.1016/j.ics.2004.01.102

Van den Belt-Dusebout, A. W., de Wit, R., Gietema, J. A., Horenblas, S., Louwman, M. W., Ribot, J. G.,… van Leeuwen, F. E. (2007). Treatment-specific risks of second malignancies and cardiovascular disease in five-year survivors of testicular cancer. <i>Journal of Clinical Oncology, 25</i>, 4370-4378.

Volkers, N. (2000). Diabetes and cancer: Scientists search for a possible link. <i>Journal of the National Cancer Institute, 92</i>, 192-194.

Weismiller, D. G. (2009). Menopause. <i>Primary Care, 36</i>, 199-226. doi: 10.1016/j.pop.2008.10.007

Yeh, E., & Bickford, C. (2009). Cardiovascular complications of cancer therapy: Incidence, pathogenesis, diagnosis, and management. <i>Journal of American College of Cardiology, 53</i>, 2231-2247.