Cancer: Follow-up

The sequelae or complications of tumor diseases are diverse and essentially depend on the type of tumor and its location. Factors affecting health status and leading to health care utilization (Z00-Z99).

  • Suicide (60% more suicides than normal population; bronchial carcinoma (lung cancer): 420%).

Cardiovascular system (I00-I99).

  • Congestive heart failure (heart failure) or cardiomyopathy (heart muscle disease):
    • Non-Hodgkin lymphoma: adjusted hazard ratio 1.94 (95% confidence interval 1.66-2.25).
    • Leukemias (blood cancers): hazard ratio 1.77 (1.50-2.09).
    • Multiple myeloma: hazard ratio 3.29 (2.59-4.18).
    • Esophageal cancer (cancer of the esophagus): hazard ratio 1.96 (1.46-2.64).
    • Bronchial carcinoma (lung cancer): hazard ratio 1.82 (1.52-2.17)
    • Renal cell carcinoma (kidney cancer): hazard ratio 1.73 (1.38-2.17).
    • Ovarian cancer (ovarian cancer): hazard ratio 1.59 (1.19-2.12).
  • Hypertension risk (high blood pressure) ↑ (prevalence (disease incidence) 2.5-fold increased with childhood cancer; e.g., after Wilms tumor (nephroblastoma) 70% hypertension at age 40 years).
  • Risk of thrombosis ↑ (due totumor-induced increase in thrombin synthesis) (approx. 20% of tumor patients)
  • Myocardial dysfunction (dysfunction of the myocardium; even without cardiotoxic chemotherapy): reduced myocardial deformation (myocardial strain)/predictor of subsequent drop in ejection fraction (EF; ejection fraction).
  • Thromboembolism (vascular occlusion (embolism) caused by an entrained thrombus (blood clot)).
    • Arterial thromboembolism (twice the risk of myocardial infarction/heart attack and apoplexy/stroke in the first six months after diagnosis; highest risk was in patients with bronchial carcinoma/lung cancer)
    • Venous thromboembolism (VTE).
      • Risk of venous thromboembolism was increased in 18 of 20 cancers; adjusted hazard ratios ranged from 1.72 (1.57-1.89) in patients with prostate carcinoma (prostate cancer) to 9.72 (5.50-17.18) in patients with pancreatic carcinoma (pancreatic cancer).
      • VTE is the 2nd leading cause of death in patients with oncologic disease [Guidelines: 1].
      • 20% of all oncology patients develop VTE during their disease course
    • Venous thromboembolism (VTE)-with childhood malignancy, the risk of late VTE is 1.1 events/1,000 person-years versus 0.5 events/1,000 person-years; multivariate analysis showed an increased long-term VTE risk in the presence of the following factors:

Infectious and parasitic diseases (A00-B99).

  • Herpes zoster (shingles) (adjusted odds ratio, OR 1.29; for hematologic malignancies, OR 2.46).

Musculoskeletal system and connective tissue (M00-M99).

  • Osteoporosis (bone loss) – tumor therapy-induced osteoporosis/osteopenia (TTIO) (long-term side effects of tumor therapy); may have a role in the development of TTI osteoporosis:

Neoplasms – tumor diseases (C00-D48).

Psyche – Nervous System (F00-F99; G00-G99).

  • Attentional disorders (probably resulting from post-traumatic stress due to diagnosis).
  • Depression
  • Peripheral neuropathies (PN) – disease of the nerves which carry information between the central nervous system and the muscles (symptoms: tingling sensation, pain but also paralysis) (long-term side effects of tumor therapy).

Symptoms and abnormal clinical and laboratory parameters not elsewhere classified (R00-R99).

  • Chronic pain (approximately one in three tumor patients).
  • Fatigue (“tumor-associated fatigue”; Cancer-related fatigue, CrF) (long-term side effects of tumor therapy).
  • Cachexia (emaciation; very severe emaciation).
  • Suicidality (suicidal tendency)

Genitourinary system (N00-N99)

  • Acute renal insufficiency (kidney failure)-particularly at risk bladder cancer, myeloma, and leukemia patients (9.3%; dialysis requirement occurred in 0.9%)
  • Urinary tract disease (glomerular disease, tubulointerstitial kidney disease, acute renal failure, chronic kidney disease, urinary tract infections, other and nonspecific diseases, urolithiasis (bladder stones), obstructive uropathy (urinary retention)) – survivors of childhood cancer were 2.5 times more likely to require hospitalization later in life; The risk was particularly high for diseases such as neuroblastoma (malignant disease of the sympathetic nervous system), kidney tumors, or leukemia (blood cancer)
  • Fertility disorders after chemotherapy/radiation therapy.
    • Men: spermatogenesis disorder – oligospermia (< 15 million sperm per ml of ejaculate; see Spermiogram for details) or azoospermia (absence of spermatozoa):
    • Women: premature ovarian failure (menopause before age 40):
      • By radiotherapy (radiatio).
        • <10th ly: > 20.3 Gy (= critical radiation dose for sterility).
        • > 10th Lj: > 18.4 Gy
        • Adults: > 16.5 Gy

Prognostic factors

  • Unhealthy diet (Western diet: high proportion of saturated fats, sugary and salty foods, white flour products, and highly processed foods, such as sausages) increased the risk of premature death by approximately 50% in former cancer patients. This could be observed especially in breast and colon cancer survivors (breast and colon cancer).The data analysis also shows that, for example, the Mediterranean diet, rich in fruits and vegetables, cereals, legumes, nuts, as well as meat, reduces mortality (death rate)
  • Chronic disease or cardiovascular risk factors may be responsible for one-fifth of all cancers and one-third of all cancer deaths, according to a prospective cohort study. The following factors shorten life due to cancer.
    • Uric acid(< 297 µmol/l; < 5.0 mg/dl): gives men a loss of 1.5 years and women a loss of 2.8 years
    • Hypertension (high blood pressure): men by 2.6 and women by 4.6 years
    • Low total cholesterol (< 4.15 mmol/l; 160 mg/dl): men by 3.1 and women by 4.2 years
    • Decreased glomerular filtration rate (60 ml/min/1.73 m2): men by 3.5 and women by 5.7 years
    • Smoking: Men by 4.3 years and women by 4.8 years
    • Diabetes mellitus: men by 5.0 and women by 5.9 years
    • Lung disease: Men by 5.8 and women by 3.7 years
    • Proteinuria (increased excretion of protein in urine): men by 6.6 years and women by 6.9 years
    • Increased heart rate (> 90 beats/min): men by 7.4 years and women by 5.4 years