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Substantial cardiovascular disease among pediatric cancer survivors
1. From this cross-sectional study, survivors of pediatric cancer who received cardiotoxic therapy experienced high rates of cardiomyopathy, coronary artery disease, valvular disease, and electrical and rhythm abnormalities.
2. The vast majority of those with cardiovascular disease were asymptomatic.
Evidence Rating Level: 2 (Good)
Study Rundown: Children with many types of once-dire cancers now often have excellent prognoses and treatments, but some such therapies may be associated with long-term health effects. To help understand potential negative long-term effects of pediatric cancer therapy, this study examined the prevalence of several types of heart disease among adult survivors of pediatric cancer. All participants had received cardiotoxic chemotherapy and/or cardiac-directed radiation therapy. Overall, participants had high prevalence of dysfunctional heart valves, disordered heart muscle (cardiomyopathy), disordered electrical conduction through the heart or disordered heart rhythm, and diseased coronary arteries. Although there was no comparison group in this study, these rates were starkly higher than would be expected in individuals of these patients’ ages. Notably, very few of these patients experienced symptoms due to their cardiac abnormalities, and most abnormalities were detected during screening for the study. This study was limited by the lack of a comparison group of patients who had not received cardiotoxic therapy, as well as by the fact that only 61% of eligible patients participated in the study, introducing the potential for selection bias. Nonetheless, the high rates of adverse cardiac outcomes among included patients suggest that rigorous screening of similar patients may be useful.
Click to read the study published today in the Annals of Internal Medicine
Relevant Reading: Survivors of Childhood Cancer in the United States: Prevalence and Burden of Morbidity.
In-Depth [cross-sectional study]: This cross-sectional study evaluated cardiac outcomes among 1853 pediatric-cancer survivors enrolled in the St. Jude Lifetime Cohort Study. To be enrolled in the cross-sectional sub-study, patients must have received anthracycline-based chemotherapy and/or cardiac-directed radiation therapy, and must have survived at least 10 years after initial cancer diagnosis. Among enrolled participants, 28.8% had evidence of valvular pathology, 7.4% had evidence of cardiomyopathy, 4.4% had abnormal cardiac conduction or rhythms, and 3.8% had evidence of coronary artery disease (CAD). Prevalence of these four outcomes generally increased as age of evaluation increased. From multivariate analysis, the cumulative anthracycline dose >250 mg/m2 was significantly associated with increased odds of cardiomyopathy (OR 2.7, 95%CI 1.1-6.9); cumulative radiation dose >1500 cGy was associated with increased odds of cardiomyopathy (OR 1.9, 95%CI 1.1-3.7), CAD (OR 10.5, 95%CI 4.2-26.3), and conduction or rhythm disorders (OR 3.5, 95%CI 1.1-10.7). Patients who had received cardiac-directed radiation >1500 cGy and anthracycline at any dose had increased odds of valvular disorders.
Image: PD
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