AIM: Childhood cancer survival may lead to later cardiac dysfunction

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Along with an increased risk of mortality, pediatric patients who survive childhood cancer may also have an increased risk of long-term abnormal cardiac function, according to a study published July 26 in the Archives of Internal Medicine.

While the survival rates for childhood cancer have increased from 20 percent in the 1940s to almost 70-80 percent today, these patients still run the risk of acquiring late treatment effects such as cardiovascular disease, the authors noted.

“Cardiovascular disease and cardiac mortality are among the most serious late effects,” they wrote. “Several population-based studies observed a six- to eight-fold increased mortality owing to cardiovascular disease among childhood cancer survivors compared with the general population.”

During this study, Helena J. van der Pal, MD, of the Emma Children’s Hospital and Academic Medical Center in Amsterdam, and colleagues evaluated 601 childhood cancer survivors who lived five years or more, to study the prevalence of left ventricular dysfunction and the impact of cardiotoxic therapies.

The researchers performed an echocardiography in patients who received anthracyclines, cardiac irradiation and high-doses of cyclophosphamide or ifosfamide—87 percent of the patients were eligible to receive an echocardiogram.

The researchers reported mean left ventricular shortening fraction rates to be 33.1 percent. Additionally, the researchers found after a mean follow-up of 15.4 years, that 27 percent of the patients had abnormal cardiac function.

While the authors noted that neither sex nor high-doses of cyclophosphamide or ifosfamide were associated with a heightened risk for cardiac dysfunction, they said that anthracycline dose and cardiac irradiation were strong predictors of subclinical cardiac dysfunction.

“The overall prevalence of 27 percent of childhood cancer survivors with cardiac dysfunction is alarmingly high in the young population,” the authors wrote.

“Continued monitoring of all childhood cancer survivors treated with potentially cardiotoxic therapy with or without subclinical cardiac dysfunction is necessary to identify childhood cancer survivors who could possibly benefit from early treatment, which could avoid further deterioration of cardiac function,” they concluded.