BACKGROUND: Cancer survivors are at an increased risk of morbidities, including cardiovascular diseases (CVD). Chemotherapy and radiation have been correlated with cardiotoxicity. However, the magnitude of these effects and ways of mitigating them are unclear. Arterial stiffness (AS) has been established as a strong predictive measure of CVD risk. Pulse wave velocity (PWV) is a gold-standard non-invasive methodology to measure AS. Therefore, the objective of this meta-analysis was to measure the effects of cancer treatment on PWV in cancer survivors. METHODS: Electronic databases were searched from inception through April 2023. The following criteria were used to select trials for inclusion in this review: (i) English language, (ii) human studies, (iii) adults, (iv) cancer patients/survivors, (v) inclusion of cancer treatment, (vi) inclusion of at least two PWV measurements (pre- and post-treatment). Out of 127 identified articles, these criteria were met by 20 articles (24 trials). Extracted data included bibliographic information, participant characteristics, and PWV measurement details. RESULTS: Cancer treatment was associated with a significant increase (worsening) in PWV (μ=0.63 m/s, 95% CI: 0.35, 0.92, k=21, p<0.01). Sub-group analysis did not reveal any effects on PWV by device (p=0.15) or site (p=0.36). However, there was a significant moderator effect for cancer type (p=0.05), with breast cancer survivors having significant decreases (μ=-0.94 m/s, 95% CI: -1.84, -0.04, k=6, p=0.04) and acute lymphoblastic leukemia survivors having significant increases (μ=1.0 m/s, 95% CI: 0.16, 1.84, k=1, p=0.02) in PWV. Additionally, there was a significant effect of time between pre- and post-treatment visits on PWV (p=0.05). Trials <12 weeks resulted in a significant increase in PWV (μ=0.57 m/s 95% CI: 0.012, 1.126, k=6, p=0.05) whereas trials >13 weeks resulted in a non-significant increase in PWV (μ=0.32 m/s, 95% CI: -0.013, 0.647, k=11, p=0.06). CONCLUSIONS: Cancer treatment increases PWV and has negative effects on AS. Coupled with low levels of physical activity and high levels of sedentary behavior, cancer treatment plays a role in the heightened CVD risk seen in cancer survivors. The interaction between these sub-optimal lifestyle behaviors and cancer treatment remains unknown. Further research is needed to identify effective interventions to mitigate their negative cardiovascular effects.

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