Grant Number:	3P01CA233432-05S1 Interpret this number
Primary Investigator:	Kushi, Lawrence
Organization:	Kaiser Foundation Research Institute
Project Title:	Clinical Care Gaps and Unmet Needs in Adolescent and Young Adult (AYA) Cancers
Fiscal Year:	2024

PROJECT SUMMARY Cancer survival in adolescents and young adults (AYAs), ages 15 to 39 years at diagnosis, has improved substantially over the last two decades. However, survivors are at increased risk of developing chronic medical conditions, at least in part due to the consequence of cancer treatment. Cardiovascular disease (CVD) is among the most common and severe late effects among AYA cancer survivors, and is the leading cause of death in the United States (US). Metabolic syndrome (MetS) is a condition that includes a cluster of risk factors for CVD, such as diabetes, hypertension, high triglyceride, low high-density lipoprotein (HDL) cholesterol levels, and obesity. MetS incidence is increasing among young adults in the US, which may be in part explained by the increasing prevalence of obesity in the general population. Studies have shown a higher incidence of MetS and CVD-related mortality among childhood cancer survivors compared to the general population. Along with the direct damage to the cardiovascular system caused by chemotherapy and radiation, MetS play a role in the onset and progression of CVD in cancer survivors. However, to the best of our knowledge, no study has investigated the incidence of MetS and its association with CVD among AYA cancer survivors, who have potentially unique biological characteristics distinct from children or older adults. This limited research hinders the development of long-term survivorship care guidelines and interventions to improve health outcomes in this population. To address this important research gap, we propose to: 1) determine the cumulative incidence and relative risk of MetS in AYAs with cancer and compare them to a noncancer AYA population; 2) examine the cumulative incidence and relative risk of CVD among AYAs with cancer and compare them to a noncancer AYA population; and 3) investigate the association between MetS and CVD risk in AYA cancer survivors. We will account for sociodemographic, lifestyle, and clinical factors, including cancer therapies in these analyses. We will use data resources that integrate the clinical and research infrastructure of Kaiser Permanente Northern California (KPNC) and Southern California (KPSC), and the population-based California Cancer Registry linked to statewide healthcare utilization data. In these comprehensive and diverse data sources, we estimate a cohort of approximately 21,100 AYAs (including 9,600 from KPNC and 11,500 from KPSC) who were diagnosed between 2006 and 2020 with one of the eleven most common cancers and survived at least two years post-diagnosis. Our findings will identify subgroups of AYA cancer survivors at elevated risk of developing MetS, and who may benefit from prevention, early detection and treatment of MetS and CVD, potentially improving survival and quality of life of this population. Additionally, it may reveal risk differences by race, ethnicity, and socioeconomic factors, guiding efforts to mitigate disparities in late effects in an under-investigated population of AYA cancer survivors.





None. See parent grant details.