Skip to main content
  • AACR Publications
    • Blood Cancer Discovery
    • Cancer Discovery
    • Cancer Epidemiology, Biomarkers & Prevention
    • Cancer Immunology Research
    • Cancer Prevention Research
    • Cancer Research
    • Clinical Cancer Research
    • Molecular Cancer Research
    • Molecular Cancer Therapeutics

AACR logo

  • Register
  • Log in
  • My Cart
Advertisement

Main menu

  • Home
  • About
    • The Journal
    • AACR Journals
    • Subscriptions
    • Permissions and Reprints
    • Reviewing
  • Articles
    • OnlineFirst
    • Current Issue
    • Past Issues
    • CEBP Focus Archive
    • Meeting Abstracts
    • Progress and Priorities
    • Collections
      • COVID-19 & Cancer Resource Center
      • Disparities Collection
      • Editors' Picks
      • "Best of" Collection
  • For Authors
    • Information for Authors
    • Author Services
    • Best of: Author Profiles
    • Informing Public Health Policy
    • Submit
  • Alerts
    • Table of Contents
    • Editors' Picks
    • OnlineFirst
    • Citation
    • Author/Keyword
    • RSS Feeds
    • My Alert Summary & Preferences
  • News
    • Cancer Discovery News
  • COVID-19
  • Webinars
  • Search More

    Advanced Search

  • AACR Publications
    • Blood Cancer Discovery
    • Cancer Discovery
    • Cancer Epidemiology, Biomarkers & Prevention
    • Cancer Immunology Research
    • Cancer Prevention Research
    • Cancer Research
    • Clinical Cancer Research
    • Molecular Cancer Research
    • Molecular Cancer Therapeutics

User menu

  • Register
  • Log in
  • My Cart

Search

  • Advanced search
Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
  • Home
  • About
    • The Journal
    • AACR Journals
    • Subscriptions
    • Permissions and Reprints
    • Reviewing
  • Articles
    • OnlineFirst
    • Current Issue
    • Past Issues
    • CEBP Focus Archive
    • Meeting Abstracts
    • Progress and Priorities
    • Collections
      • COVID-19 & Cancer Resource Center
      • Disparities Collection
      • Editors' Picks
      • "Best of" Collection
  • For Authors
    • Information for Authors
    • Author Services
    • Best of: Author Profiles
    • Informing Public Health Policy
    • Submit
  • Alerts
    • Table of Contents
    • Editors' Picks
    • OnlineFirst
    • Citation
    • Author/Keyword
    • RSS Feeds
    • My Alert Summary & Preferences
  • News
    • Cancer Discovery News
  • COVID-19
  • Webinars
  • Search More

    Advanced Search

Research Articles

The Contribution of Stress and Distress to Cardiovascular Health in Adult Survivors of Childhood Cancer

Margaret M. Lubas, Mingjuan Wang, John L. Jefferies, Kirsten K. Ness, Matthew J. Ehrhardt, Kevin R. Krull, Daniel A. Mulrooney, Deo Kumar Srivastava, Rebecca M. Howell, Leslie L. Robison, Melissa M. Hudson, Gregory T. Armstrong and Tara M. Brinkman
Margaret M. Lubas
1Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mingjuan Wang
2Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
John L. Jefferies
3Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kirsten K. Ness
1Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Matthew J. Ehrhardt
1Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
4Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Matthew J. Ehrhardt
Kevin R. Krull
1Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
5Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Kevin R. Krull
Daniel A. Mulrooney
1Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
4Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Daniel A. Mulrooney
Deo Kumar Srivastava
2Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rebecca M. Howell
6Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Leslie L. Robison
1Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Melissa M. Hudson
1Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
4Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Melissa M. Hudson
Gregory T. Armstrong
1Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
4Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tara M. Brinkman
1Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
5Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: tara.brinkman@stjude.org
DOI: 10.1158/1055-9965.EPI-20-1183 Published February 2021
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

This article requires a subscription to view the full text. You may purchase access to this article or login to access your subscription using the links below.

Abstract

Background: Childhood cancer survivors are at risk for cardiovascular morbidity and mortality that is not fully explained by cancer-directed therapies. We examined the contribution of emotional stress and distress to cardiac health in adult survivors of childhood cancer.

Methods: Participants included 3,267 adult survivors enrolled in the St. Jude Lifetime Cohort Study [median (range) 29.9 (18.1–64.5) years of age; 7.7 (0–24.8) years at diagnosis; 48.4% female]. Survivors completed comprehensive medical assessments and standardized measures of depression, anxiety, posttraumatic stress symptoms (PTSS), and perceived stress. Cardiovascular-related conditions included hypertension, diabetes, dyslipidemia, cardiomyopathy, dysrhythmia, myocardial infarction (severity graded 0–4), and metabolic syndrome (yes/no). Multivariable modified Poisson models examined associations between symptoms of stress/distress and cardiovascular outcomes. Longitudinal associations between stress/distress and new-onset cardiovascular outcomes, defined as a change from grade ≤1 at initial evaluation to grade ≥2 at follow-up (median 3.9 years) were examined in 1,748 participants.

Results: In multivariable cross-sectional models, stress/distress was associated with hypertension [risk ratio (RR) = 1.24; 95% confidence interval (CI), 1.07–1.43], dyslipidemia (RR = 1.29; 95% CI, 1.03–1.61), and metabolic syndrome (RR = 1.35; 95% CI, 1.17–1.54) independent of known cardiovascular risk factors. In longitudinal models, stress/distress was associated with new-onset dysrhythmia (RR = 2.87; 95% CI, 1.21–6.78), perceived stress with hypertension (RR = 1.42; 95% CI, 1.04–1.95), and PTSS and anxiety with dyslipidemia (RR = 1.72; 95% CI, 1.13–2.62; RR = 1.54; 95% CI, 1.01–2.35, respectively).

Conclusions: Stress/distress is independently associated with adverse cardiovascular outcomes among childhood cancer survivors.

Impact: Improving psychological health may serve as a potential intervention target for optimizing cardiac health among childhood cancer survivors.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Cancer Epidemiol Biomarkers Prev 2021;30:286–94

  • Received August 6, 2020.
  • Revision received October 8, 2020.
  • Accepted November 19, 2020.
  • Published first November 24, 2020.
  • ©2020 American Association for Cancer Research.
View Full Text

Log in using your username and password

Forgot your user name or password?

Purchase access

You may purchase access to this article. This will require you to create an account if you don't already have one.
PreviousNext
Back to top
Cancer Epidemiology Biomarkers & Prevention: 30 (2)
February 2021
Volume 30, Issue 2
  • Table of Contents
  • Table of Contents (PDF)
  • Editorial Board (PDF)

Sign up for alerts

View this article with LENS

Open full page PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for sharing this Cancer Epidemiology, Biomarkers & Prevention article.

NOTE: We request your email address only to inform the recipient that it was you who recommended this article, and that it is not junk mail. We do not retain these email addresses.

Enter multiple addresses on separate lines or separate them with commas.
The Contribution of Stress and Distress to Cardiovascular Health in Adult Survivors of Childhood Cancer
(Your Name) has forwarded a page to you from Cancer Epidemiology, Biomarkers & Prevention
(Your Name) thought you would be interested in this article in Cancer Epidemiology, Biomarkers & Prevention.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
The Contribution of Stress and Distress to Cardiovascular Health in Adult Survivors of Childhood Cancer
Margaret M. Lubas, Mingjuan Wang, John L. Jefferies, Kirsten K. Ness, Matthew J. Ehrhardt, Kevin R. Krull, Daniel A. Mulrooney, Deo Kumar Srivastava, Rebecca M. Howell, Leslie L. Robison, Melissa M. Hudson, Gregory T. Armstrong and Tara M. Brinkman
Cancer Epidemiol Biomarkers Prev February 1 2021 (30) (2) 286-294; DOI: 10.1158/1055-9965.EPI-20-1183

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
The Contribution of Stress and Distress to Cardiovascular Health in Adult Survivors of Childhood Cancer
Margaret M. Lubas, Mingjuan Wang, John L. Jefferies, Kirsten K. Ness, Matthew J. Ehrhardt, Kevin R. Krull, Daniel A. Mulrooney, Deo Kumar Srivastava, Rebecca M. Howell, Leslie L. Robison, Melissa M. Hudson, Gregory T. Armstrong and Tara M. Brinkman
Cancer Epidemiol Biomarkers Prev February 1 2021 (30) (2) 286-294; DOI: 10.1158/1055-9965.EPI-20-1183
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Introduction
    • Materials and Methods
    • Results
    • Discussion
    • Authors' Disclosures
    • Authors' Contributions
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF
Advertisement

Related Articles

Cited By...

More in this TOC Section

  • Gallstones and Gallbladder Cancer
  • Additive Effects of Aristolochic Acid and Arsenic in UTUC
  • Provider Lifestyle Discussions
Show more Research Articles
  • Home
  • Alerts
  • Feedback
  • Privacy Policy
Facebook   Twitter   LinkedIn   YouTube   RSS

Articles

  • Online First
  • Current Issue
  • Past Issues

Info for

  • Authors
  • Subscribers
  • Advertisers
  • Librarians

About Cancer Epidemiology, Biomarkers & Prevention

  • About the Journal
  • Editorial Board
  • Permissions
  • Submit a Manuscript
AACR logo

Copyright © 2021 by the American Association for Cancer Research.

Cancer Epidemiology, Biomarkers & Prevention
eISSN: 1538-7755
ISSN: 1055-9965

Advertisement