Childhood cancer survivors at risk for cardiac events

Helena J. van der Pal, M.D., Ph.D., of the Emma Children's Hospital/Academic Medical Center in Amsterdam, and colleagues evaluated the long-term risk for symptomatic CEs in a hospital-based cohort of 1,362 five-year CCSs who were diagnosed between 1966 and 1996.

The researchers identified 50 CEs, including 27 cases of congestive heart failure, in 42 survivors, which occurred at a median of 27.1 years of age. The 30-year cause-specific cumulative incidence of CEs was 12.6 percent for those who were treated with anthracyclines and cardiac irradiation, 7.3 percent for those treated with anthracycline, and 4 percent for those treated with cardiac irradiation, which marked an increase compared with other treatments. Factors associated with developing a CE included the dose of anthracycline or cardiac irradiation, combination of these treatments, and congenital heart disease.

"CCSs have a high risk of developing symptomatic CEs at an early age," the authors write. "Survivors treated with both anthracyclines and radiotherapy have the highest risk; after 30 years, one in eight will develop severe heart disease. The use of potentially cardiotoxic treatments should be reconsidered for high-risk groups, and frequent follow-up for high-risk survivors is needed."

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Journal reference: Journal of Clinical Oncology

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