Table 1.

Summary of study characteristics (n = 21)

Author, year	Sample size	Population	Cancer type	Comorbidities	Outcomes	Study design
Multiple comorbidities
Birand, 2019 [33]	• 81	• 65.4% female • Race NR • Mean age 59.1 (SD 11.34) • North Cyprus	• Breast • GI • Genitourinary • Gynecology • Lung • Lymphoma • Others	Condition: • Hyperlipidemia • Hypertension • Diabetes • Asthma • Hyperthyroid • Hypothyroidism • Others Medication: • Oral chemotherapies • Medicines used for chronic illnesses • All medicines used during chemotherapy cycles	Primary: • Beliefs about medications (Beliefs about Medicines Questionnaire) Secondary: • Morisky Green Levine Test (MGLT) (aka Morisky Medication Adherence Scale) — score of 4 indicated adherence	• Pro
Calip, 2017 [34]	• 2,308	• 100% female • 87.4% white • 3.9% AA • 8.7% Others (Asian, American Indian, unknown) • Median age 67 (IQR 57–75) • 1% 18–39 yrs • 8.6% 40–49 yrs • 20.6% 50–59 yrs • 27.7% 60–69 yrs • 28.1% 70–79 yrs • 14% ≥ 80 yrs • USA	• Breast	Condition: • Hypertension • Diabetes • Hyperlipidemia Medication: • Antihypertensives (angiotensin converting-enzyme inhibitors, beta blockers, calcium channel blockers, diuretics) • Oral diabetes meds (metformin, sulfonylureas) • Statins	Primary: • MPR during the 2nd year post-cancer diagnosis • Non-adherence defined as MPR <0.80 Secondary: • NR	• Retro • Data linkage
Dashputre, 2019 [35]	• CML = 1,378 • CLL/SLL − 1,126 • MM = 3,527	• CML: • 43.9% female CLL/SLL: • 34.6% female MM: • 44% female • Race NR CML: • Mean age 54.7 (SD 14.8) CLL/SLL: • Mean age 67.2 (SD 11.4) MM: • Mean age 63.8 (SD 11.0) • USA	• CML • CLL/SLL • MM	Condition: • Diabetes • Hypertension • Hyperlipidemia **Pre-existing for all Medication: • Chronic conditions (anti-diabetic, antihypertensive, lipid-lowering agent) • Oral oncolytics	Primary: • PDC ≥ 80% (changed to 85%, 90% in sensitivity analyses) Secondary: • NR	• Retro
Drzayich Antol, 2018 [36]	• 1,847 • (524 w/ CRC, 623 w/ lung, 700 w/ breast)	• 66.8% female • 84.9% white • 13.0% non-white • 0.3% unknown **Only reported for 1,624 Medicare pts • Mean age 69.2 (SD 9.2) • USA	• Breast • Lung • CRC **All metastatic	Condition: • Ischemia • CVD • Hypertension • Diabetes • Others (anemia, anxiety, depression, renal disease, pneumonia) Medication: • NR	Primary: • 8-item Morisky Medication Adherence Scale (MMAS) Secondary: • Unhealthy days	• Cross-sect • Retro
Santorelli, 2016 [37]	• 298 (BC + diabetes) and 1,192 comparators • 508 (B + lipid disorder) and 2,032 comparators • 1,062 (BC + HTN) and 4,282 comparators	• 100% female BC + DM: • 73.2% white • 12.4% black • 14.4% others BC + lipid: • 87.8% white • 5.7% black • 6.5% other BC + HTN: • 83.7% white • 8.8% black • 7.5% others BC + DM: • 24.8% 66–69 yrs • 28.2% 70–74 yrs • 23.5% 75–79 yrs • 14.1% 80–84 yrs • 9.4% 85 + yrs BC + lipid: • 23.2% 66–69 yrs • 26.4% 70–74 yrs • 23% 75–79 yrs • 16.3% 80–84 yrs • 11% 85 + yrs BC + HTN: • 20% 66–69 yrs • 25.9% 70–74 yrs • 21.6% 75–79 yrs • 17.4% 80–84 yrs • 15.2% 85 + yrs • USA	• Breast	Condition: • Diabetes • Lipid disorders • Hypertension Medication: • All oral diabetes meds. (excluded those on insulin) • Any antihypertensive • Statins	Primary: • PDC (non-adherent < 80%; changed to 70% and 90% in sensitivity analysis) • Persistence (largest # of consecutive days w/o coverage by med. class → 26 days for hypertension and diabetes; 62 days for lipids) Secondary: • NR	• Retro
Yang, 2016 [38]	• 36,149	• 100% female • Race NR • 13.6% 18–54 yrs • 34.1% 55–64 yrs • 52.4% ≥ 65 yrs • USA	• Early stage breast cancer (ESBC)	Condition: • Hypertension • Hyperlipidemia • Diabetes • Thyroid disease • GERD • Osteoporosis Medication: • Hypertension (diuretics, CA channel blocker, beta-blocker, ACE inhibitor, angiotensin-II receptor blocker, alpha blocker, alpha-2 receptor agonist, peripheral adrenergic inhibitor) • Hyperlipidemia (anti-hyperlipidemic agent, bile acid sequestrants, cholesterol absorption inhibitors, fibric acid derv., PCSK9 inhibitors, statins) • Diabetes (insulin, alpha-glucosidase inhibitors, amylin analogs, incretin mimetics, meglitinides, non/sulfonylurea, SGLT-2 inhibitors, thiazolidinediones)	Primary: • MPR ≥ 80% • Compared change in adherence pre/post cancer treatment (20% decline considered sig. change) Secondary: • NR	• Retro
Zhou, 2019 [39]	• 25,381 (23,349 chemo only [reference grp], 1382 autologous HCT, 650 allogeneic HCT)	Chemo: • 47.1% female Auto HCT: • 39.4% female Allo HCT: • 42.5% female • Race NR Chemo: • Mean age 50.3 (SD 11.8) Auto HCT: • Mean age 54.2 (SD 8.4) Allo HCT: • Mean age 50 (SD 11.7) • USA	• Blood cancer	Condition: • Diabetes • Hypertension • Dyslipidemia Medication: • NR	Primary: • Medication discontinuation (treatment gap ≥60 days) • Medication adherence (PDC ≥ 0.80) Secondary: • NR	• Retro
Diabetes
Calip, 2015 [40]	• 509 (of 516 treated with oral diabetes medications)	• 100% female • 82% white • 5.0% AA • 13% others (Asian, American Indian/Alaska native, unknown) **Reported for 516 pts • Median age at BC diagnosis = 65 • Median age at BC diagnosis = 643 (IQR 11.4) **2nd measure is for 516 pts • USA	• Breast	Condition: • Diabetes Medication: • Oral diabetes medications	Primary: • MPR; % adherent (MPR ≥ 0.80) • Discontinuation rates (gap ≥ 90 days btw. end of previous supply and subsequent medication) Secondary: • HbA1C	• Retro
James, 2018 [41]	• 56	• 52% female • 40% White • 27% Black • 32% Other (Asian, other races) • Mean age 62.2 (SD 9.2) • USA	• Prostate • Breast • Lung • CRC	Condition: • Diabetes Medication: • Oral hypoglycemic agents	Primary: • Diabetes self-management behaviors, including self-reported medication adherence • 8-item Morisky Medication Adherence Scale (MMAS); non-adherence defined as a positive answer to > 2 questions on the MMAS Secondary: • Other DM self-mgt. behaviors (Summary of Diabetes Self-care Activities)	• Pro
Letinier, 2018 [42]	• 13,943 (654 w/cancer; 13,289 w/o cancer)	Cancer: • 34.9% female Non-cancer: • 49.6% female • Race NR Cancer: • Mean age 66.3 (SD 10.1) Non-cancer: • Mean age 59.3 (SD 14.2) • France	Main analysis: • All Secondary analysis: • CRC • Pulmonary • Prostate • Breast • Others	Condition: • Diabetes Medication: • Biguanides • Sulfonylureas • Sulfonamide • Alpha glucosidases inhibitors • Thiazolidinediones • Dipeptidyl peptidase 4 (DPP-4) inhibitors • Other diabetes medicines • Combinations of the above	Primary: • Medication persistence — nonpersistent at occurrence of first OAD discontinuation (refill gaps of 90 days; 60 days in sensitivity analysis) • Sensitivity analysis where pts. taking insulin were excluded Secondary: • NR	• Retro
Stuart, 2015 [43]	• 4,348 pre-exiting diabetes with cancer • 28,507 controls (diabetics without cancer)	Cancer: • 61.9% female Non-cancer: • 66.9% female Cancer: • 78% white • 13.5% black • 8.4% others (including Hispanics) Non-cancer: • 74.7% white • 14.9% black • 10.4% others (including Hispanics) Cancer: • 13.3% <65 yrs • 17.7% 65–69 yrs • 20.4% 70–74 yrs • 21.1% 75–79 yrs • 15.8% 80–84 yrs • 11.6% > 84 yrs Non-cancer: • 24% < 65 yrs • 17.7% 65–69 yrs • 18.5% 70–74 yrs • 17.3% 75–79 yrs • 12.3% 80–84 yrs • 10.2% > 84 yrs • USA	• New cancer diagnosis	Condition: • Diabetes Medication: • Oral hypoglycemic agents (OHAs) • Renin–angiotensin–aldosterone system inhibitors (RAAS-I) • Statins	Primary: • PDC (6 months pre/post diagnosis/index date) Secondary: • NR	• Retro
Tan, 2016 [44]	• 1,918 (cancer and diabetes) • 1,918 matched non-cancer controls	• 56.5% female • Race NR • Mean age 56.7 (SD NR) • 28.4% 18–54 years • 42.1% 55–60 yrs • 29.5% 61–64 yrs • USA	• Breast • Prostate • Colon • Lung	Condition: • Diabetes Medication: • Oral anti-diabetic (sulfonylureas, thiazolidinediones [TZD], metformin, dipeptidyl peptidase 4 [DPP-4] inhibitors	Primary: • Adherence to oral antidiabetic medications among different regimens and cancer types and cancers cases and matched cancer-free controls • Assessed using MPR (for each patient & each drug class) • 0.8 ≤ MPR ≤ 1 is adherent Secondary: • All-cause hospitalization and ER visits • Total medical costs (inpatient, outpatient, emergency room)	• Retro • Data linkage
Zanders, 2015 [45]	• 3,281 cancer patients • 12,891 controls w/o cancer	Cancer: • 44% female Control: • 44% female • Race NR Cancer: • mean age 67.7 (SD 9.8) Control: • mean age 67.5 (SD 9.7) **Age at first diabetes drug dispensing • Netherlands	• Any cancer (except nonmelanoma skin) 6 most frequent: • Colorectal • Other GI (esophageal, stomach, pancreas, liver) • Prostate • Breast • Pulmonary • Urinary	Condition: • Diabetes Medication: • Anti-diabetic/glucose lowering drug (metformin monotherapy, sulfonylurea monotherapy, any insulin and others)	Primary: • Change in MPR associated with cancer diagnosis (calculated every month) Secondary: • NR	• Retro • Data linkage
Hyperlipidemia
Banegas, 2018 [46]	• 10,177	• 39.1% female • 63.8% White, non-Hispanic • 9.2% AA, non-Hispanic • 21% others (Hispanic, non-Hispanic Asian, Native American, multirace, unknown) • 5.8% < 55 yrs • 26.4% 55–64 yrs • 42% 65–74 yrs • 25.8% 75 + yrs • USA	• Breast • CRC • Prostate	Condition: • NR Medication: • Statins (prevalent users)	Primary: • PDC during 4 periods (12–24 months before cancer dx, 0–11 months before cancer dx, month of cancer to 11 months after cancer dx, and 12–24 months after cancer dx) • PDC ≥ 0.80 → adherent; 0.20–0.79 → partially adherent; <0.20 → non-adherent Secondary: • PDC during the same periods by race and ethnicity	• Retro
Calip, 2013 [47]	• 1,393 (with ≥ 1 statin medication prior to cancer dx)	• 100% female • 86.8% white • 3.8% AA • 9.8% others (Asian, American Indian, unknown) • Mean age 62.4 (SD 11.0) • USA	• Breast	Condition: • Hyperlipidemia Medication: • Statins (prevalent users)	Primary: • MPR ≥ 80% (adherent) • Discontinuation rates (gap ≥ 90 days btw, supplies) Secondary: • LDL, HDL levels	• Retro
Feng, 2021 [48]	• 20,046 (breast cancer) • 11,719 (colorectal cancer) • 6,430 (melanoma)	• 100% female9 Breast cancer: • Mean age of 70.1 Colorectal cancer: • Mean age of 73.6 Melanoma: • Mean age of 71.9 • Australia • Race NR	• Breast • CRC • Melanoma	Condition: • Hyperlipidemia Medication: • Lipid lowering medications (primarily statins)	Primary: • Breast cancer mortality • CRC mortality • Melanoma mortality • Any cancer mortality • Non-cancer mortality • All-cause mortality Secondary: • NR	• Retro • Data linkage
Hypertension
Jeong, 2015 [49]	• 56 breast cancer survivors • 280 non-cancer controls	• 100% female **Both cohorts • Race NR Cancer: • Mean age 65.7 (SD 1.7) Cancer: • Mean age 65.7 (SD 1.7) **After PSM • Korea	• Breast	Condition: • Hypertension Medication: • Antihypertensive	Primary: • Antihypertensive medication use was measured by monthly frequency • Good adherence defined as daily medication Secondary: • Health behaviors (alcohol consumption, smoking, diet control, physical activity)	• Retro • Cross-sect
Jo, 2015 [50]	• 480 in final analysis (80 cancer; 400 non-cancer) • **After PSM	Cancer: • 38.4% female Non-cancer: • 38% female • Race NR Cancer: • Mean age 69.2 (SD 1.26) Non-cancer: • Mean age 69.0 (SD 1.46) • Korea	• Gastric	Condition: • Hypertension Medication: Antihypertensive	Primary: • Antihypertensive medication was measured by frequency (per month) • Good adherence was daily medication; levels below this were not sufficient adherence Secondary: • Health behaviors (alcohol consumption, smoking, diet control, physical activity)	• Retro
Shin, 2010 [51]	• 2,455,193 (include 12,636 cancer survivors)	• Cancer: • 55.1% female General pop: • 57.8% female • Race NR Cancer: • 0.7% 20–39 yrs • 6.7% 40–49 yrs • 20.8% 50–59 yrs • 36.1% 60–69 yrs. 4 • 35.7% >/ = 70 yrs General Pop: • 2.9% 20–39 yrs • 13.7% 40–49 yrs • 26.6% 50–59 yrs • 31.2% 60–69 yrs • 25.6% >/ = 70 yrs • Korea	• Oral cavity and pharynx • Esophagus • Stomach • CRC • Liver • Gallbladder • Pancreas • Larynx • Lung • Melanoma • Breast • Cervix uteri • Corpus uteri • Ovary • Prostate • Testis • Kidney • Bladder • Brain and CNS • Thyroid • Hodgkin’s lymphoma • NHL • MM • Leukemia	Condition: • Hypertension Medication: • Antihypertensive	Primary: • CMA scale (% of days patient has pills available — calculated by dividing total number of days of medication dispensed (excluding the final prescription) by total number of days between the 1 st and last prescriptions) • CMA reported as continuous (median and IQR and proportion) appropriate adherence = cumulative medication adherence 80 + % Secondary: • NR	• Retro • Data linkage
Shin, 2012 [52]	• 1,956 cancer patients (include 385 w/ HTN) • 1,124 comparison group w/HTN & w/o cancer)	Cancer: • 48.8% female General pop: • 56.1% female • Race NR Cancer: • Mean age 65.2 (SD 8.9) General pop: • Mean age 59.9 (SD 12.2) • Korea	• Stomach • Lung • CRC • Breast • Others (includes all other types of cancer)	Condition: • Hypertension Medication: Antihypertensive	Primary: • Questionnaires in relation to anti-hypertensive medication adherence Secondary: • Questionnaires in relation to frequency BP monitoring and perceived BP control	• Cross-sect
Other CVD-related risk factors
Cheung, 2013 [53]	• 1,119 cancer survivors (CS) • 7,886 propensity score-matched non-cancer patients (NCP)	Cancer: • 65% female Non-cancer: • 67% female Cancer: • 92% white Non-cancer: • 91% white Cancer: • Mean 80.6 (SD 6.9) Non-cancer: • Mean 80.5 (SD 7.2) • USA	• Cancer survivors	Condition: • Secondary prevention of myocardial infarction (MI) Medication: • Statins • Beta-blockers • Angiotensin-converting enzyme inhibitors (ACEIs) • Angiotensin-II receptor blockers (ARBs)	Primary: • PDC Secondary: • Receipt of revascularization procedures	• Retro • Data linkage

Abbreviations:aOR adjusted odds ratio; CI confidence interval; CLL chronic lymphocytic leukemia; CML chronic myeloid leukemia; CNS central nervous system; CRC colorectal cancer; CVD cardiovascular disease; D-in-D difference in difference; GERD gastroesophageal reflux disease; GI gastrointestinal; OR odds ratio; MM multiple myeloma; MPR medication possession ratio; NHL non-Hodgkin lymphoma; NR not reported; PDC proportion of days covered; Pro prospective; PSM propensity score matching; Retro retrospective; SLL small lymphocytic leukemia