Spouses, Relatives of Patients With GU Cancer Face Elevated Cardiovascular, Psychological Comorbidity Risks

Spouses and first-degree relatives of patients with genitourinary (GU) cancer faced increased risks of developing cardiovascular and psychological comorbidities, according to a study published in Cancer.¹

The researchers explained that having a family member diagnosed with cancer can be highly traumatic for the entire family, but it can especially affect those closest to the patient. It impacts family members in various ways, including physically and psychologically; common feelings for family members of patients with cancer include distress, fear, and anxiety.

Past studies generally evaluated psychological adjustments at a single time point or shorter intervals, making it difficult to assess large cohorts over longer periods. Also, the direct health effects of cancer-related stress on family members are less understood.²

Spouses and first-degree relatives of patients with genitourinary (GU) cancers face increased risks of developing cardiovascular and psychological comorbidities. | Image Credit: LIGHTFIELD STUDIOS - stock.adobe.com

For the new study, researchers investigated the potential impacts of a cancer diagnosis on cardiovascular and psychological health in a large population of spouses and relatives of patients with cancer over a longer period.¹ They also explored whether specific characteristics of patients with cancer or their family members led to a greater development risk of psychological and cardiovascular comorbidities. Follow-up was completed at 1-, 3-, and 5-year intervals.

The psychological illnesses evaluated included anxiety, depression, and mood disorders. Additionally, the cardiovascular diseases evaluated included heart failure, hypertensive disease, myocardial infarction, and cerebrovascular disease.

The researchers identified their study population using the Utah Population Database (UPDB), a population-level data resource that contains individual-level information on most people residing in Utah³; it houses various patient information, including age, hospital diagnoses, sex, and family history.

Consequently, they used the UPDB’s genealogical, demographic, and health data since it allowed for the linkage of administrative and medical data to depict the patient and their family's history.¹ More specifically, the researchers focused on the UPDB’s GU cancer subset, which includes patients with prostate, bladder, kidney, testis, and penile cancers.

The researchers identified all incident GU cancers diagnosed between 1990 and 2015 from the Utah Cancer Registry based on the International Classification of Diseases, 9th Revision (ICD-9) and ICD, 10th Revision (ICD-10) diagnosis codes. Familial linkage was then completed using the UPDB, with extracted information containing health, demographic, and pedigree data on patients with GU cancers (cases), their spouses, and their first-degree relatives.

The researchers excluded patients residing outside of Utah, along with first-degree relatives and spouses with psychological or cardiovascular diseases diagnosed before a family member’s cancer diagnosis. Also, a control group was created by matching cases with GU cancer-free controls based on age, sex, and state of residence at a 5:1 ratio.

The researchers identified 49,284 patients diagnosed with GU cancer between 1990 and 2015 and subsequently identified 246,775 matched controls. By creating familial networks, they identified 77,938 first-degree relatives and spouses for the case population and 81,022 for the control population.

Of the case relatives and spouses, 5529 (7.1%) were diagnosed with a psychological illness after a family member's cancer diagnosis. Therefore, the risk of developing a psychological illness post-diagnosis was higher among case first-degree relatives/spouses than control first-degree relatives/spouses. More specifically, it was 10% higher (HR, 1.10; 95% CI, 1.00-1.20) at 1-year post-diagnosis, 5% higher (HR, 1.05; 95% CI, 1.10-1.11) at 3 years, and 4% higher (HR, 1.04; 95% CI, 1.00-1.08) at 5 years.

For the cardiovascular disease analysis, the researchers identified 77,607 case first-degree relatives/spouses and 81,225 control first-degree relatives/spouses. Of the case relatives, 5922 (7.6%) were diagnosed with cardiovascular disease after a family member's cancer diagnosis.

Therefore, the risk of developing cardiovascular disease post-diagnosis was significantly higher among case first-degree relatives/spouses than control first-degree relatives/spouses. More specifically, it was 28% higher (HR, 1.28; 95% CI, 1.17-1.41) at 1-year post-diagnosis, 16% higher (HR, 1.16; 95% CI, 1.11-1.22) at 3 years, and 14% higher (HR, 1.14; 95% CI, 1.10-1.18) at 5 years.

Compared with other relationships, the researchers determined that parents of children with cancer were at an increased risk of developing cardiovascular or psychological comorbidities within 1 year of diagnosis. Similarly, spouses of patients with cancer who passed away within 1 year of their diagnosis were at an increased risk of developing cardiovascular or psychological comorbidities.

Overall, living closer to those with cancer was associated with worse outcomes for relatives. Lastly, relatives of those with kidney and bladder cancers were at the highest risk of developing psychological and cardiovascular illnesses; conversely, relatives of patients with testis cancer were at the lowest risk.

The researchers acknowledged their limitations, one being their data set's limited racial and ethnic diversity. Since they used the UPDB, their data set was limited to those within the Utah region, which is 90% White. Also, the researchers believed their study underestimated the development of negative health outcomes in spouses and first-degree relatives since it was centered around GU cancer. Consequently, they suggested areas for future research.

“Further work is needed to investigate the psychological and cardiovascular impact of spouses and first-degree relatives of patients of all racial/ethnic groups and cancer types,” the authors concluded.

References

1. Choudry MM, Murray N, Dindinger-Hill K, et al. Genitourinary cancer and family: The reverberating psychological and cardiovascular effects of a genitourinary cancer diagnosis on first-degree relatives and spouses. Cancer. doi:10.1002/cncr.35486
2. Pitceathly C, Maguire P. The psychological impact of cancer on patients' partners and other key relatives: a review. Eur J Cancer. 2003;39(11):1517-1524. doi:10.1016/s0959-8049(03)00309-5
3. Utah population database. University of Utah Health. May 27, 2022. Accessed September 9, 2024. https://uofuhealth.utah.edu/huntsman/utah-population-database