Table 2.

Challenges in investigating cardiovascular risk in cancer survivors

• Separating the impact of cancer treatment from the impact of the cancer itself • Disentangling the impact of cancer and cancer treatment from that of shared risk factors (e.g. smoking, diet, physical activity, comorbidities) and normal ageing • Adjusting for cancer-related factors in analysis that are often not available in databases (e.g. cancer treatment, cancer stage) • Adjusting for non-cancer-related factors in analysis (e.g. shared risk factors, comorbidities, competing risk of death) • Adjusting for the changing cardiovascular risk posed by cancer treatments as these treatments evolve over time • Ensuring appropriate follow-up to capture late cardiovascular effects of treatment • Capturing data in adult cohorts in a field where much of the data is in paediatric cohorts