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Hammoud RA, Liu Q, Dixon SB, Onerup A, Mulrooney DA, Huang IC, Jefferies JL, Rhea IB, Ness KK, Ehrhardt MJ, Hudson MM, Ky B, Bhakta N, Sapkota Y, Yasui Y, Armstrong GT. The burden of cardiovascular disease and risk for subsequent major adverse cardiovascular events in survivors of childhood cancer: a prospective, longitudinal analysis from the St Jude Lifetime Cohort Study. Lancet Oncol 2024; 25:811-822. [PMID: 38821086 DOI: 10.1016/s1470-2045(24)00157-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The effect of the increasing lifetime burden of non-major cardiovascular conditions on risk for a subsequent major adverse cardiovascular event among survivors of childhood cancer has not been assessed. We aimed to characterise the prevalence of major adverse cardiovascular events and their association with the cumulative burden of non-major adverse cardiovascular events in childhood cancer survivors. METHODS This is a longitudinal cohort study with participant data obtained from an ongoing cohort study at St Jude Children's Research Hospital: the St Jude Lifetime Cohort Study (SJLIFE). Prospective clinical follow-up was of 5-year survivors of childhood cancer who were diagnosed when aged younger than 25 years from 1962 to 2012. Age-frequency, sex-frequency, and race-frequency matched community-control participants completed a similar one-time clinical assessment. 22 cardiovascular events were graded using a St Jude Children's Research Hospital-modified version of the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03). Cumulative incidence and burden of the primary outcome of major adverse cardiovascular events (cardiomyopathy, myocardial infarction, stroke, and other cardiovascular-related mortality) were estimated. Rate ratios (RR) of the association of major adverse cardiovascular events with 22 non-major adverse cardiovascular events were estimated using multivariable piecewise-exponential regression adjusting for attained age, age at diagnosis, sex, race and ethnicity, treatment era, diagnosis of diabetes, and exposure to cardiotoxic cancer therapies. The St Jude Lifetime Cohort study is registered with ClinicalTrials.gov, NCT00760656, and is ongoing. FINDINGS 9602 5-year survivors of childhood cancer, and 737 community controls were included in the longitudinal follow-up (from Sept 13, 2007, to Dec 17, 2021). The median follow-up was 20·3 years (IQR 12·0-31·4) from the date of primary cancer diagnosis (4311 [44.9%] were females). By the age of 50 years (analysis stopped at age 50 years due to the low number of participants older than that age), the cumulative incidence of major adverse cardiovascular events among survivors was 17·7% (95% CI 15·9-19·5) compared with 0·9% (0·0-2·1) in the community controls. The cumulative burden of major adverse cardiovascular events in survivors was 0·26 (95% CI 0·23-0·29) events per survivor compared with 0·009 (0·000-0·021) events per community control participant. Increasing cumulative burden of grade 1-4 non-major adverse cardiovascular events was associated with an increased future risk of major adverse cardiovascular events (one condition: RR 4·3, 95% CI 3·1-6·0; p<0·0001; two conditions: 6·6, 4·6-9·5; p<0·0001; and three conditions: 7·7, 5·1-11·4; p<0·0001). Increased risk for major adverse cardiovascular events was observed with specific subclinical conditions (eg, grade 1 arrhythmias [RR 1·5, 95% CI 1·2-2·0; p=0·0017]), grade 2 left ventricular systolic dysfunction (2·2, 1·6-3·1; p<0·0001), grade 2 valvular disorders (2·2, 1·2-4·0; p=0·013), but not grade 1 hypercholesterolaemia, grade 1-2 hypertriglyceridaemia, or grade 1-2 vascular stenosis. INTERPRETATION Among an ageing cohort of survivors of childhood cancer, the accumulation of non-major adverse cardiovascular events, including subclinical conditions, increased the risk of major adverse cardiovascular events and should be the focus of interventions for early detection and prevention of major adverse cardiovascular events. FUNDING The US National Cancer Institute and the American Lebanese Syrian Associated Charities.
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Affiliation(s)
- Rawan A Hammoud
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Qi Liu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Stephanie B Dixon
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Aron Onerup
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - John L Jefferies
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Isaac B Rhea
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Bonnie Ky
- Department of Cardiovascular Medicine and Abramson Cancer Center, Thalheimer Center for Cardio-Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nickhill Bhakta
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yadav Sapkota
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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2
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Aznar MC, Bergler-Klein J, Boriani G, Cutter DJ, Hurkmans C, Levis M, López-Fernández T, Lyon AR, Maraldo MV. Cardiovascular toxicities of radiotherapy: From practical issues to new perspectives. Radiother Oncol 2024:110336. [PMID: 38797493 DOI: 10.1016/j.radonc.2024.110336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Marianne C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, the United Kingdom of Great Britain and Northern Ireland.
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - David J Cutter
- Nuffield Department of Population Health, University of Oxford, Oxford, the United Kingdom of Great Britain and Northern Ireland; Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, the United Kingdom of Great Britain and Northern Ireland
| | - Coen Hurkmans
- Dept of Radiation Therapy, Catharina Hospital Eindhoven, the Netherlands; Dept of Electrical Engineering and Dept of Applied Physics, Technical University Eindhoven, the Netherlands
| | - Mario Levis
- Cardiology Department, Cardio-Oncology Unit, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain; Cardiology Department, Cardio-Oncology Unit, Quironsalud Madrid University Hospital, Madrid, Spain
| | | | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital, London, the United Kingdom of Great Britain and Northern Ireland
| | - Maja V Maraldo
- Dept of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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3
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Abrahão R, Brunson A, Ruddy KJ, Li Q, Li J, Ryder MM, Chubak J, Nichols HB, Sauder CAM, Gray MF, Hahn EE, Wun T, Keegan THM. Late endocrine diseases in survivors of adolescent and young adult cancer in California: a population-based study. Br J Cancer 2024; 130:1166-1175. [PMID: 38332179 PMCID: PMC10991490 DOI: 10.1038/s41416-024-02594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Cancer survivors have increased risk of endocrine complications, but there is a lack of information on the occurrence of specific endocrinopathies at the population-level. METHODS We used data from the California Cancer Registry (2006-2018) linked to statewide hospitalisation, emergency department, and ambulatory surgery databases. We estimated the cumulative incidence of and factors associated with endocrinopathies among adolescents and young adults (AYA, 15-39 years) who survived ≥2 years after diagnosis. RESULTS Among 59,343 AYAs, 10-year cumulative incidence was highest for diabetes (4.7%), hypothyroidism (4.6%), other thyroid (2.2%) and parathyroid disorders (1.6%). Hypothyroidism was most common in Hodgkin lymphoma, leukaemia, breast, and cervical cancer survivors, while diabetes was highest among survivors of leukaemias, non-Hodgkin lymphoma, colorectal, cervical, and breast cancer. In multivariable models, factors associated with increased hazard of endocrinopathies were treatment, advanced stage, public insurance, residence in low/middle socioeconomic neighbourhoods, older age, and non-Hispanic Black or Hispanic race/ethnicity. Haematopoietic cell transplant was associated with most endocrinopathies, while chemotherapy was associated with a higher hazard of ovarian dysfunction and hypothyroidism. CONCLUSIONS We observed a high burden of endocrinopathies among AYA cancer survivors, which varied by treatment and social factors. Evidence-based survivorship guidelines are needed for surveillance of these diseases.
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Affiliation(s)
- Renata Abrahão
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | | | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Judy Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Mabel M Ryder
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Candice A M Sauder
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA
- Comprehensive Cancer Center, University of California Davis Medical Center, Sacramento, CA, USA
| | - Marlaine F Gray
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Erin E Hahn
- Kaiser Permanente Southern California, Research and Evaluation, Pasadena, CA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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von Grundherr J, Elmers S, Koch B, Hail LA, Mann J, Escherich G, Bergelt C, Samland L, Jensen W, Vettorazzi E, Stark M, Valentini L, Baumann FT, Singer S, Reer R, Beller R, Calaminus G, Faber J, Classen CF, Gebauer J, Hilgendorf I, Koehler M, Puzik A, Salzmann N, Sander A, Schiffmann L, Sokalska-Duhme M, Schuster S, Kock-Schoppenhauer AK, Bokemeyer C, Sinn M, Stein A, Dwinger S, Salchow J. A Multimodal Lifestyle Psychosocial Survivorship Program in Young Cancer Survivors: The CARE for CAYA Program-A Randomized Clinical Trial Embedded in a Longitudinal Cohort Study. JAMA Netw Open 2024; 7:e242375. [PMID: 38526495 DOI: 10.1001/jamanetworkopen.2024.2375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Importance There is a lack of trials examining the effect of counseling interventions for child, adolescent, and younger adult (CAYA) cancer survivors. Objective To assess lifestyle habits and the psychosocial situation of CAYAs to determine the efficacy of needs-based interventions in the CARE for CAYA program (CFC-P). Design, Setting, and Participants The CFC-P was conducted as a multicenter program in 14 German outpatient clinics, mainly university cancer centers. Recruitment began January 1, 2018; a randomized clinical trial was conducted until July 15, 2019; and intervention was continued as a longitudinal cohort study until March 31, 2021. Data preparation was conducted from April 1, 2021, and analysis was conducted from August 14, 2021, to May 31, 2022. Herein, predefined confirmatory analyses pertain to the RCT and descriptive results relate to the overall longitudinal study. Data analysis was based on the full analysis set, which is as close as possible to the intention-to-treat principle. Intervention A comprehensive assessment determined needs in physical activity, nutrition and psychooncology. Those with high needs participated in 1 to 3 modules. In the RCT, the IG received 5 counseling sessions plus newsletters, while the control group CG received 1 counseling session. Main Outcomes and Measures The primary outcome was the change in the rate of CAYAs with high needs at 52 weeks. Secondary outcomes were feasibility, modular-specific end points, satisfaction, quality of life, and fatigue. Results Of 1502 approached CAYAs aged 15 to 39 years, 692 declined participation. Another 22 CAYAs were excluded, resulting in 788 participants. In the randomized clinical trial, 359 CAYAs were randomized (intervention group [IG], n = 183; control group [CG], n = 176), and 274 were followed up. In the RCT, the median age was 25.0 (IQR, 19.9-32.2) years; 226 were female (63.0%) and 133 male (37.0%). After 52 weeks, 120 CAYAs (87.0%) in the IG and 115 (86.5%) in the CG still had a high need in at least 1 module (odds ratio, 1.04; 95% CI, 0.51-2.11; P = .91). Both groups reported reduced needs, improved quality of life, reduced fatigue, and high satisfaction with the CFC-P. Conclusions and Relevance In this randomized clinical trial, the implementation of a lifestyle program in this cohort was deemed necessary, despite not meeting the primary outcome. The interventions did not alter the rate of high needs. The results may provide guidance for the development of multimodal interventions in the follow-up care of CAYAs. Trial Registration German Clinical Trial Register: DRKS00012504.
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Affiliation(s)
- Julia von Grundherr
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Elmers
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Hematology and Oncology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Koch
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lesley-Ann Hail
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Hematology and Oncology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Mann
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Medical Psychology, Greifswald University Medicine, Greifswald, Germany
| | - Luisa Samland
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wiebke Jensen
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luzia Valentini
- Faculty of Agriculture and Food Sciences, University of Applied Sciences, Neubrandenburg, Germany
| | - Freerk T Baumann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital of Cologne, Cologne, Germany
| | - Susanne Singer
- Institute for Medical Biostatistics, Epidemiology and Informatics, Division of Epidemiology and Health Services Research, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Rüdiger Reer
- Institute of Human Movement Science, Faculty of Psychology and Human Movement, University of Hamburg, Hamburg, Germany
| | - Ronja Beller
- Clinic for Pediatrics III, Department of Pediatric Hematology/Oncology, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Venusberg Campus 1, Bonn, Germany
| | - Jörg Faber
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Cancer Center, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Carl Friedrich Classen
- Pediatric Oncology and Palliative Care Section, University Medicine Rostock, Childrens' and Adolescents Hospital Rostock, Rostock, Germany
| | - Judith Gebauer
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, Jena, Deutschland
| | - Michael Koehler
- Department of Hematology and Oncology, University Hospital Magdeburg, Magdeburg, Germany
- Specialty Practice for Psycho-Oncology, Magdeburg, Germany
| | - Alexander Puzik
- Department of Pediatric Hematology and Oncology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicole Salzmann
- Pediatric Hematology and Oncology, University Children´s Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany
| | - Annette Sander
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Lisa Schiffmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, CCC WERA, University Hospital Würzburg, Würzburg, Germany
| | - Magdalena Sokalska-Duhme
- Department of Pediatric Hematology, Oncology & Immunology, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Sonja Schuster
- Pediatric Hematology and Oncology, Department of Pediatrics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Carsten Bokemeyer
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marianne Sinn
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Stein
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Dwinger
- Department for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jannike Salchow
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Jiang C, Xu H, Wu Y. Effect of chemotherapy in tumor on coronary arteries: Mechanisms and management. Life Sci 2024; 338:122377. [PMID: 38135114 DOI: 10.1016/j.lfs.2023.122377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
Coronary artery disease (CAD) is an important contributor to the cardiovascular burden in cancer survivors. The development of coronary ischemia events, myocardial infarction, and heart failure has been associated with many conventional chemotherapeutic agents, new targeted therapies, and immunotherapy. The most frequent pathological manifestations of chemotherapy-mediated coronary damage include acute vasospasm, acute thrombosis, accelerated atherosclerosis development, and microvascular dysfunction. Potential screening techniques for CAD patients include baseline risk factor evaluation, polygenic risk factors, and coronary artery calcium scores. Determining the risk requires consideration of both the type of chemotherapy and the type of cancer being treated. Cardiology-oncology guidelines offer some suggestions for the care of coronary artery disease, which might involve medication, lifestyle changes, and coronary revascularization.
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Affiliation(s)
- Chengqing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haiyan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Hammoud RA, Mulrooney DA, Rhea IB, Yu C, Johnson JN, Chow EJ, Ehrhardt MJ, Hudson MM, Ness KK, Armstrong GT, Dixon SB. Modifiable Cardiometabolic Risk Factors in Survivors of Childhood Cancer: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2024; 6:16-32. [PMID: 38510292 PMCID: PMC10950443 DOI: 10.1016/j.jaccao.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 03/22/2024] Open
Abstract
The growing community of childhood cancer survivors faces a heavy burden of late onset morbidities and mortality, with cardiovascular diseases being the leading noncancer cause. In addition to demographics and cancer treatment exposures, which cannot be altered, cardiometabolic risk factors (obesity, hypertension, diabetes, and dyslipidemia) and frailty potentiate the risk of morbidity and mortality associated with chronic health conditions. Important opportunities exist to target these risk factors and improve late health outcomes for survivors. Unfortunately, limited evidence exists on the optimal methods to prevent, screen, and treat cardiometabolic risk factors among survivors, resulting in significant underdiagnosis and undertreatment. In this review, we discuss the prevalence of, risk factors for, current survivor-specific recommendations, and gaps in knowledge to mitigate potentially modifiable cardiometabolic risk factors and frailty among survivors of childhood cancer.
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Affiliation(s)
- Rawan A. Hammoud
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Isaac B. Rhea
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christine Yu
- Department of Pediatric Medicine, Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jason N. Johnson
- Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Eric J. Chow
- Fred Hutchinson Cancer Center, Seattle Children’s Hospital, University of Washington, Seattle, Washington, USA
| | - Matthew J. Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Stephanie B. Dixon
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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7
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Colori A, Ackwerh R, Chang YC, Cody K, Dunlea C, Gains JE, Gaunt T, Gillies CMS, Hardy C, Lalli N, Lim PS, Soto C, Gaze MN. Paediatric radiotherapy in the United Kingdom: an evolving subspecialty and a paradigm for integrated teamworking in oncology. Br J Radiol 2024; 97:21-30. [PMID: 38263828 PMCID: PMC11027255 DOI: 10.1093/bjr/tqad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 01/25/2024] Open
Abstract
Many different malignancies occur in children, but overall, cancer in childhood is rare. Survival rates have improved appreciably and are higher compared with most adult tumour types. Treatment schedules evolve as a result of clinical trials and are typically complex and multi-modality, with radiotherapy an integral component of many. Risk stratification in paediatric oncology is increasingly refined, resulting in a more personalized use of radiation. Every available modality of radiation delivery: simple and advanced photon techniques, proton beam therapy, molecular radiotherapy, and brachytherapy, have their place in the treatment of children's cancers. Radiotherapy is rarely the sole treatment. As local therapy, it is often given before or after surgery, so the involvement of the surgeon is critically important, particularly when brachytherapy is used. Systemic treatment is the standard of care for most paediatric tumour types, concomitant administration of chemotherapy is typical, and immunotherapy has an increasing role. Delivery of radiotherapy is not done by clinical or radiation oncologists alone; play specialists and anaesthetists are required, together with mould room staff, to ensure compliance and immobilization. The support of clinical radiologists is needed to ensure the correct interpretation of imaging for target volume delineation. Physicists and dosimetrists ensure the optimal dose distribution, minimizing exposure of organs at risk. Paediatric oncology doctors, nurses, and a range of allied health professionals are needed for the holistic wrap-around care of the child and family. Radiographers are essential at every step of the way. With increasing complexity comes a need for greater centralization of services.
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Affiliation(s)
- Amy Colori
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Raymond Ackwerh
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Yen-Ch’ing Chang
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Kristy Cody
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Cathy Dunlea
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Jennifer E Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Trevor Gaunt
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Callum M S Gillies
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Claire Hardy
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Narinder Lalli
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Pei S Lim
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Carmen Soto
- Department of Paediatric Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
- Department of Oncology, UCL Cancer Institute, University College London, London, WC1E 6DD, United Kingdom
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8
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de Beijer IAE, Skinner R, Haupt R, Grabow D, Bardi E, Beccaria A, Nieto AC, Essiaf S, Filbert AL, Gsell H, Kienesberger A, Langer T, McColgan P, Muraca M, Rascon J, Tallone R, Tomasikova Z, Uyttebroeck A, Kremer LCM, van der Pal HJH, Mulder RL. European recommendations for short-term surveillance of health problems in childhood, adolescent and young adult cancer survivors from the end of treatment to 5 years after diagnosis: a PanCare guideline. J Cancer Surviv 2023:10.1007/s11764-023-01493-z. [PMID: 38048011 DOI: 10.1007/s11764-023-01493-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Childhood, adolescent and young adult (CAYA) cancer survivors require ongoing surveillance for health problems from the end of cancer treatment throughout their lives. There is a lack of evidence-based guidelines on optimal surveillance strategies for the period from the end of treatment to 5 years after diagnosis. We aimed to address this gap by developing recommendations for short-term surveillance of health problems based on existing long-term follow-up (LTFU) care guidelines. METHODS The guideline working group, consisting of healthcare professionals, parents and survivor representatives from 10 countries, worked together to identify relevant health problems that may occur in survivors between the end of treatment and 5 years after diagnosis and to develop recommendations for short-term surveillance of health problems. The recommendations were drawn from existing LTFU guidelines and adapted where necessary based on clinical expertise. RESULTS The working group developed 44 recommendations for short-term surveillance of health problems, which were divided into four categories based on the level of surveillance required: awareness only (n = 11), awareness, history and/or physical examination without surveillance test (n = 15), awareness, history and/or physical examination with potential surveillance test (n = 1) and awareness, history and/or physical examination with surveillance test (n = 17). CONCLUSION The development of a guideline for short-term surveillance of health problems fills a critical gap in survivorship care for CAYA cancer survivors, providing much-needed support immediately after treatment up to 5 years after diagnosis. IMPLICATIONS FOR CANCER SURVIVORS This guideline will support healthcare professionals to provide appropriate follow-up care and improve the quality of life of CAYA cancer survivors.
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Affiliation(s)
- Ismay A E de Beijer
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| | - Roderick Skinner
- Wolfson Childhood Cancer Research Centre, Newcastle University Centre for Cancer, Herschel Building, Brewery Lane, Newcastle Upon Tyne, NE1 7RU, UK
- Great North Children's Hospital, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4 LP, UK
- Translational and Clinical Research Institute, Wolfson Childhood Cancer Research Centre, Herschel Building, Brewery Lane, Newcastle Upon Tyne, NE1 7RU, UK
| | | | - Desiree Grabow
- Division of Childhood Cancer Epidemiology/German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Edit Bardi
- St. Anna Children's Hospital, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
| | | | | | - Samira Essiaf
- European Society for Paediatric Oncology, C/O BLSI, Clos Chapelle-Aux-Champs 30, Bte 1.30.30, Brussels, Belgium
| | - Anna-Liesa Filbert
- Division of Childhood Cancer Epidemiology/German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Thorsten Langer
- Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Lubeck, Germany
| | - Patricia McColgan
- Childhood Cancer Ireland, Carmichael House, 4 Brunswick Street North, Dublin, D07 RHA8, Ireland
| | | | - Jelena Rascon
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | | | - Leontien C M Kremer
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Helena J H van der Pal
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Renée L Mulder
- Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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9
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Ehrhardt MJ, Krull KR, Bhakta N, Liu Q, Yasui Y, Robison LL, Hudson MM. Improving quality and quantity of life for childhood cancer survivors globally in the twenty-first century. Nat Rev Clin Oncol 2023; 20:678-696. [PMID: 37488230 DOI: 10.1038/s41571-023-00802-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
The contributions of cooperative groups to performing large-cohort clinical trials and long-term survivorship studies have facilitated advances in treatment, supportive care and, ultimately, survival for patients with paediatric cancers. As a result, the number of childhood cancer survivors in the USA alone is expected to reach almost 580,000 by 2040. Despite these substantial improvements, childhood cancer survivors continue to have an elevated burden of chronic disease and an excess risk of early death compared with the general population and therefore constitute a large, medically vulnerable population for which delivery of high-quality, personalized care is much needed. Data from large survivorship cohorts have enabled the identification of compelling associations between paediatric cancers, cancer therapy and long-term health conditions. Effectively translating these findings into clinical care that improves the quality and quantity of life for survivors remains an important focus of ongoing research. Continued development of well-designed clinical studies incorporating dissemination and implementation strategies with input from patient advocates and other key stakeholders is crucial to overcoming these gaps. This Review highlights the global progress made and future efforts that will be needed to further increase the quality and quantity of life-years gained for childhood cancer survivors.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Global Paediatric Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Qi Liu
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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10
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Abstract
Importance An estimated 15 000 children and adolescents aged 0 to 19 years are diagnosed with cancer each year in the US, and more than 85% survive for at least 5 years. By 45 years of age, approximately 95% of people who survive childhood cancer will develop a significant health problem related to the childhood cancer diagnosis or its treatment. Observations Approximately 500 000 people currently alive in the US have survived childhood cancer. The most common severe or life-threatening chronic health problems related to childhood cancer or its treatment are endocrine disorders such as hypothyroidism or growth hormone deficiency (44%), subsequent neoplasms such as breast cancer or thyroid cancer (7%), and cardiovascular disease such as cardiomyopathy or congestive heart failure, coronary artery disease, and cerebrovascular disease (5.3%). Medical conditions related to a cancer diagnosis during childhood or adolescence are most commonly caused by the radiation therapy and the chemotherapies used to treat cancer and may develop at varying lengths of time after exposure to these treatments. Individuals at highest risk for developing treatment-related health problems include patients with brain cancer treated with cranial irradiation (approximately 70% develop severe or life-threatening health problems) and allogeneic hematopoietic stem cell transplant recipients (approximately 60% develop severe or life-threatening health problems). Individuals at the lowest risk for developing treatment-related health problems include those who survived solid tumors (such as Wilms tumor) treated with surgical resection alone or with minimal chemotherapy, for whom the prevalence of subsequent health problems is similar to people who did not have cancer during childhood or adolescence. People diagnosed with childhood cancer in the 1990s who survived for at least 5 years after the cancer diagnosis have a shorter lifespan (by about 9 years) vs children who were not diagnosed with cancer in the 1990s. Conclusions and Relevance Approximately 500 000 individuals currently alive in the US have survived childhood cancer. The most common adverse effects in individuals who survived childhood cancer are endocrine disorders, subsequent neoplasms, and cardiovascular disease. There is a need for clinicians and patients to have heightened awareness of these complications.
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Affiliation(s)
- Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, Heersink School of Medicine, University of Alabama at Birmingham
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Heersink School of Medicine, University of Alabama at Birmingham
| | - Emily S Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, Heersink School of Medicine, University of Alabama at Birmingham
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Heersink School of Medicine, University of Alabama at Birmingham
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11
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Abdalla T, Walwyn T, White D, Choong CS, Bulsara M, Preen DB, Ohan JL. Hospitalizations and Cost of Inpatient Care for Physical Diseases in Survivors of Childhood Cancer in Western Australia: A Longitudinal Matched Cohort Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1249-1259. [PMID: 37409970 DOI: 10.1158/1055-9965.epi-22-1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/28/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The long-term effects of childhood cancer are unclear in the Australian context. We examined hospitalization trends for physical diseases and estimated the associated inpatient care costs in all 5-year childhood cancer survivors (CCS) diagnosed in Western Australia (WA) from 1982 to 2014. METHODS Hospitalization records for 2,938 CCS and 24,792 comparisons were extracted from 1987 to 2019 (median follow-up = 12 years, min = 1, max = 32). The adjusted hazard ratio (aHR) of hospitalization with 95% confidence intervals (CI) was estimated using the Andersen-Gill model for recurrent events. The cumulative burden of hospitalizations over time was assessed using the mean cumulative count method. The adjusted mean cost of hospitalization was estimated using the generalized linear models. RESULTS We identified a higher risk of hospitalization for all-cause (aHR, 2.0; 95% CI, 1.8-2.2) physical disease in CCS than comparisons, with the highest risk for subsequent malignant neoplasms (aHR, 15.0; 95% CI, 11.3-19.8) and blood diseases (aHR, 6.9; 95% CI, 2.6-18.2). Characteristics associated with higher hospitalization rates included female gender, diagnosis with bone tumors, cancer diagnosis age between 5 and 9 years, multiple childhood cancer diagnoses, multiple comorbidities, higher deprivation, increased remoteness, and Indigenous status. The difference in the mean total hospitalization costs for any disease was significantly higher in survivors than comparisons (publicly funded $11,483 United States Dollar, P < 0.05). CONCLUSIONS The CCS population faces a significantly higher risk of physical morbidity and higher cost of hospital-based care than the comparisons. IMPACT Our study highlights the need for long-term follow-up healthcare services to prevent disease progression and mitigate the burden of physical morbidity on CCS and hospital services.
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Affiliation(s)
- Tasnim Abdalla
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Thomas Walwyn
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Paediatric and Adolescent Oncology and Hematology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Daniel White
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Catherine S Choong
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jeneva L Ohan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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12
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Leerink JM, Ehrhardt MJ, van Dalen EC. A call for harmonized surveillance recommendations in cardio-oncology. Eur Heart J 2023; 44:3017-3018. [PMID: 37350756 DOI: 10.1093/eurheartj/ehad268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Affiliation(s)
- Jan M Leerink
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, Utrecht, The Netherlands
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Noord-Holland, The Netherlands
| | - Matthew J Ehrhardt
- Department of Oncology and Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA
| | - Elvira C van Dalen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Noord-Holland, The Netherlands
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13
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López-Fernández T, Lyon AR. Harmonizing the cardiovascular care of adult patients with cancer. Eur Heart J 2023; 44:3019-3020. [PMID: 37351594 DOI: 10.1093/eurheartj/ehad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Affiliation(s)
- Teresa López-Fernández
- Cardiology Department, La PAz University Hospital, IdiPAZ Research Institute, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital, Guys and St. Thomas NHS Foundation Trust, South Parade, Chelsea, London SW3 6LP, UK
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14
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Gebauer J, Baust K, Bardi E, Grabow D, Calaminus G, Ronckers CM, Langer T. Updated International Guidelines for Survivorship Care after Pediatric Cancer: Practice Implications in a German and Austrian Comprehensive Care Network. Oncol Res Treat 2023; 46:382-389. [PMID: 37517391 PMCID: PMC10614471 DOI: 10.1159/000530970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/24/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Timely diagnosis of treatment-related chronic health conditions in childhood cancer survivors (CCS) may result in reduced long-term morbidity and mortality. Evidence-based guidelines serve as a tool to implement risk-adapted screening examinations in long-term follow-up (LTFU) of CCS. SUMMARY New international LTFU guidelines from the last 3 years have been reviewed and included into a practical LTFU tool in order to provide an updated summary of LTFU recommendations. The inclusion of 13 new LTFU guidelines as well as 25 pragmatic recommendations resulted in an updated LTFU plan for implantation in daily practice. Special consideration of psychosocial and mental health aspects as well as recommendations for pregnant CCS complement holistic LTFU care. KEY MESSAGES Risk-adapted LTFU in CCS offers the possibility for early detection and treatment of late effects. As these LTFU recommendations aim at asymptomatic individuals, benefits and potential risks of regular screening examinations have to be carefully balanced. Implementation of current evidence-based guidelines in clinical practice as well as the development of new application tools such as the Survivorship Passport can contribute to an individualized LTFU approach in order to ensure long-term health and quality of life in CCS.
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Affiliation(s)
- Judith Gebauer
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Katja Baust
- Pediatric Hematology and Oncology, University Children’s Hospital Bonn, Bonn, Germany
| | - Edit Bardi
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital, Linz, Austria
- St Anna Kinderspital, Vienna, Austria
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology and German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gabriele Calaminus
- Pediatric Hematology and Oncology, University Children’s Hospital Bonn, Bonn, Germany
| | - Cécile M. Ronckers
- Division of Childhood Cancer Epidemiology and German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thorsten Langer
- Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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15
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Tolani D, Wilcox J, Shyam S, Bansal N. Cardio-oncology for Pediatric and Adolescent/Young Adult Patients. Curr Treat Options Oncol 2023:10.1007/s11864-023-01100-4. [PMID: 37296365 DOI: 10.1007/s11864-023-01100-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 06/12/2023]
Abstract
OPINION STATEMENT As chemotherapy continues to improve the lives of patients with cancer, understanding the effects of these drugs on other organ systems, and the cardiovascular system in particular, has become increasingly important. The effects of chemotherapy on the cardiovascular system are a major determinant of morbidity and mortality in these survivors. Although echocardiography continues to be the most widely used modality for assessing cardiotoxicity, newer imaging modalities and biomarker concentrations may detect subclinical cardiotoxicity earlier. Dexrazoxane continues to be the most effective therapy for preventing anthracycline-induced cardiomyopathy. Neurohormonal modulating drugs have not prevented cardiotoxicity, so their widespread, long-term use for all patients is currently not recommended. Advanced cardiac therapies, including heart transplant, have been successful in cancer survivors with end-stage HF and should be considered for these patients. Research on new targets, especially genetic associations, may produce treatments that help reduce cardiovascular morbidity and mortality.
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Affiliation(s)
- Drishti Tolani
- Division of Pediatric Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Julia Wilcox
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sharvari Shyam
- Division of Pediatrics, St. Barnabas Hospital, Bronx, NY, USA
| | - Neha Bansal
- Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, New York, NY, USA.
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16
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Dixon SB, Liu Q, Chow EJ, Oeffinger KC, Nathan PC, Howell RM, Leisenring WM, Ehrhardt MJ, Ness KK, Krull KR, Mertens AC, Hudson MM, Robison LL, Yasui Y, Armstrong GT. Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet 2023; 401:1447-1457. [PMID: 37030315 PMCID: PMC10149583 DOI: 10.1016/s0140-6736(22)02471-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 04/10/2023]
Abstract
BACKGROUND 5-year survival after childhood cancer does not fully describe life-years lost due to childhood cancer because there are a large number of deaths occurring beyond 5-years (late mortality) related to cancer and cancer treatment. Specific causes of health-related (non-recurrence, non-external) late mortality and risk reduction through modifiable lifestyle and cardiovascular risk factors are not well described. Through using a well-characterised cohort of 5-year survivors of the most common childhood cancers, we evaluated specific health-related causes of late mortality and excess deaths compared with the general US population and identified targets to reduce future risk. METHODS In this multi-institutional, hospital-based, retrospective cohort study, late mortality (death ≥5 years from diagnosis) and specific causes of death were evaluated in 34 230 5-year survivors of childhood cancer diagnosed at an age younger than 21 years from 1970 to 1999 at 31 institutions in the USA and Canada; median follow-up from diagnosis was 29 years (range 5-48) in the Childhood Cancer Survivor Study. Demographic, self-reported modifiable lifestyle (ie, smoking, alcohol, physical activity, and BMI) and cardiovascular risk factors (ie, hypertension, diabetes, and dyslipidaemia) associated with health-related mortality (which excludes death from primary cancer and external causes and includes death from late effects of cancer therapy) were evaluated. FINDINGS 40-year cumulative all-cause mortality was 23·3% (95% CI 22·7-24·0), with 3061 (51·2%) of 5916 deaths from health-related causes. Survivors 40 years or more from diagnosis experienced 131 excess health-related deaths per 10 000 person-years (95% CI 111-163), including those due to the top three causes of health-related death in the general population: cancer (absolute excess risk per 10 000 person-years 54, 95% CI 41-68), heart disease (27, 18-38), and cerebrovascular disease (10, 5-17). Healthy lifestyle and absence of hypertension and diabetes were each associated with a 20-30% reduction in health-related mortality independent of other factors (all p values ≤0·002). INTERPRETATION Survivors of childhood cancer are at excess risk of late mortality even 40 years from diagnosis, due to many of the leading causes of death in the US population. Modifiable lifestyle and cardiovascular risk factors associated with reduced risk for late mortality should be part of future interventions. FUNDING US National Cancer Institute and the American Lebanese Syrian Associated Charities.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Qi Liu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Eric J Chow
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Paul C Nathan
- Division of Hematology and Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Rebecca M Howell
- Radiation Physics Department, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy M Leisenring
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Clinical Statistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Matthew J Ehrhardt
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutaka Yasui
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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17
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Ehrhardt MJ, Dixon SB, Belsky J, Hochberg J. Late effects and frontline treatment selection for children with non-Hodgkin lymphoma. Best Pract Res Clin Haematol 2023; 36:101443. [PMID: 36907640 DOI: 10.1016/j.beha.2023.101443] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Approximately 1 in 640 adults between 20 and 40 years of age is a survivor of childhood cancer. However, survival has often come at the expense of increased risk of long-term complications, including chronic health conditions and higher mortality rates. Similarly, long-term survivors of childhood non-Hodgkin lymphoma (NHL) experience significant morbidity and mortality related to prior cancer treatments, highlighting the importance of primary and secondary prevention strategies to mitigate late toxicity. As a result, effective treatment regimens for pediatric NHL have evolved to reduce both short- and long-term toxicity through cumulative dose reductions and elimination of radiation. The establishment of effective regimens facilitates shared decision-making opportunities for frontline treatment selection that considers efficacy, acute toxicity, convenience, and late effects of treatments. The current review seeks to merge current frontline treatment regimens with survivorship guidelines to enhance understanding of potential long-term health risks to facilitate best treatment practices.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Stephanie B Dixon
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer Belsky
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jessica Hochberg
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
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18
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Abstract
Cardio-oncology is a subspecialty that provides cardiac care for patients with cancer. Newer oncological agents have not only increased survivorship, but also sprouted novel cardiovascular toxicity (CVT) involving any component of the cardiovascular system, albeit with some preferential targets. Patients with cancer should undergo a baseline cardiovascular risk assessment and have individualised surveillance planned during cancer therapy and post treatment. The early diagnosis of CVT, by clinical history and examination along with imaging and laboratory analysis, is paramount. Management includes cardioprotective strategies and multidisciplinary decision-making regarding the risk-benefit ratio of oncological treatment based on CVT.
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Affiliation(s)
- Vera Vaz Ferreira
- Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Arjun K Ghosh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK and Hatter Cardiovascular Institute, University College London Hospital NHS Foundation Trust, London, UK
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19
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43:4229-4361. [PMID: 36017568 DOI: 10.1093/eurheartj/ehac244] [Citation(s) in RCA: 664] [Impact Index Per Article: 332.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022; 23:e333-e465. [PMID: 36017575 DOI: 10.1093/ehjci/jeac106] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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21
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Gálvez LC, Redondo EA, Lorenzo CC, Fernández TL. Advanced Echocardiographic Techniques in Cardio-Oncology: the Role for Early Detection of Cardiotoxicity. Curr Cardiol Rep 2022; 24:1109-1116. [PMID: 35881319 DOI: 10.1007/s11886-022-01728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Implementation of advanced echocardiographic techniques in cardio-oncology is a growing need as they are the cornerstone of early detection of cancer therapy-related cardiovascular toxicity (CTR-CVT). RECENT FINDINGS Three-dimensional echocardiography and myocardial deformation techniques have shown more accuracy and reproducibility than classic 2D measurements in detecting cardiovascular adverse effects in patients undergoing anticancer therapies. Application of advanced echo techniques to daily monitoring of patients with cancer helps to identify those at risk of developing CTR-CVT during and after cancer treatment. Furthermore, advanced echo parameters improve early initiation of cardioprotective treatments in order to minimize cardiovascular events and cancer treatment interruption.
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Affiliation(s)
- Lucía Cobarro Gálvez
- Cardiology Department, La Paz University Hospital, Paseo de La Castellana, 261, 28046, Madrid, Spain.
| | - Emilio Arbas Redondo
- Cardiology Department, La Paz University Hospital, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | | | - Teresa López Fernández
- Cardio-Oncology Unit, La Paz University Hospital, Paseo de La Castellana, Cardiology Department, 261, 28046, Madrid, Spain
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22
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Sapkota Y, Liu Q, Li N, Bhatt NS, Ehrhardt MJ, Wilson CL, Wang Z, Jefferies JL, Zhang J, Armstrong GT, Hudson MM, Robison LL, Mulrooney DA, Yasui Y. Contribution of Genome-Wide Polygenic Score to Risk of Coronary Artery Disease in Childhood Cancer Survivors. JACC CardioOncol 2022; 4:258-267. [PMID: 35818558 PMCID: PMC9270604 DOI: 10.1016/j.jaccao.2022.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Adverse cardiovascular outcomes such as coronary artery disease (CAD) are the leading noncancer causes of morbidity and mortality among childhood cancer survivors. Objectives The aim of this study was to assess the role of a genome-wide polygenic score (GPS) for CAD, well validated in the general population, and its interplay with cancer-related risk factors among childhood cancer survivors. Methods In a cohort study of 2,472 5-year childhood cancer survivors from the St. Jude Lifetime Cohort, the association between the GPS and the risk of CAD was performed using Cox regression models adjusted for age at cancer diagnosis, sex, cumulative dose of anthracyclines, and mean heart radiation dose. Results Among survivors of European ancestry, the GPS was significantly associated with the risk of CAD (HR per 1 SD of the GPS: 1.25; 95% CI: 1.04-1.49; P = 0.014). Compared with the first tertile, survivors in the upper tertile had a greater risk of CAD (1.51-fold higher HR of CAD [95% CI: 0.96-2.37; P = 0.074]), although the difference was not statistically significant. The GPS-CAD association was stronger among survivors diagnosed with cancer at age <10 years exposed to >25 Gy heart radiation (HR top vs. bottom tertile of GPS: 15.49; 95% CI: 5.24-45.52; Ptrend = 0.005) but not among those diagnosed at age ≥10 years (Ptrend ≥ 0.77) and not among those diagnosed at age <10 years exposed to ≤25 Gy heart radiation (Ptrend = 0.23). Among high-risk survivors, defined by an estimated relative hazard ≥3.0 from fitted Cox models including clinical risk factors alone, the cumulative incidence of CAD at 40 years from diagnosis was 29% (95% CI: 13%-45%). After incorporating the GPS into the model, the cumulative incidence increased to 48% (95% CI: 26%-69%). Conclusions Childhood cancer survivors are at risk for premature CAD. A GPS may help identify those who may benefit from targeted screening and personalized preventive interventions.
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Bergler-Klein J, Rainer PP, Wallner M, Zaruba MM, Dörler J, Böhmer A, Buchacher T, Frey M, Adlbrecht C, Bartsch R, Gyöngyösi M, Fürst UM. Cardio-oncology in Austria: cardiotoxicity and surveillance of anti-cancer therapies : Position paper of the Heart Failure Working Group of the Austrian Society of Cardiology. Wien Klin Wochenschr 2022; 134:654-674. [PMID: 35507087 PMCID: PMC9065248 DOI: 10.1007/s00508-022-02031-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/18/2022] [Indexed: 02/07/2023]
Abstract
Survival in cancer is continuously improving due to evolving oncological treatment. Therefore, cardiovascular short-term and long-term side effects gain crucial importance for overall outcome. Cardiotoxicity not only presents as heart failure, but also as treatment-resistant hypertension, acute coronary ischemia with plaque rupture or vasospasm, thromboembolism, arrhythmia, pulmonary hypertension, diastolic dysfunction, acute myocarditis and others. Recent recommendations have proposed baseline cardiac risk assessment and surveillance strategies. Major challenges are the availability of monitoring and imaging resources, including echocardiography with speckle tracking longitudinal strain (GLS), serum biomarkers such as natriuretic peptides (NT-proBNP) and highly sensitive cardiac troponins. This Austrian consensus encompasses cardiotoxicity occurrence in frequent antiproliferative cancer drugs, radiotherapy, immune checkpoint inhibitors and cardiac follow-up considerations in cancer survivors in the context of the Austrian healthcare setting. It is important to optimize cardiovascular risk factors and pre-existing cardiac diseases without delaying oncological treatment. If left ventricular ejection fraction (LVEF) deteriorates during cancer treatment (from >10% to <50%), or myocardial strain decreases (>15% change in GLS), early initiation of cardioprotective therapies (angiotensin-converting enzyme inhibitors, angiotensin or beta receptor blockers) is recommended, and LVEF should be reassessed before discontinuation. Lower LVEF cut-offs were recently shown to be feasible in breast cancer patients to enable optimal anticancer treatment. Interdisciplinary cardio-oncology cooperation is pivotal for optimal management of cancer patients.
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Affiliation(s)
- Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria.,BioTechMed Graz, Graz, Austria
| | - Markus Wallner
- Division of Cardiology, Medical University of Graz, Graz, Austria.,Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Marc-Michael Zaruba
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Dörler
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Internal Medicine and Cardiology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Armin Böhmer
- Department of Internal Medicine 1, Krems University Clinic, Krems, Austria
| | - Tamara Buchacher
- Department of Internal Medicine and Cardiology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Maria Frey
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Rupert Bartsch
- Department of Medicine 1, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Mariann Gyöngyösi
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ursula-Maria Fürst
- Department of Internal Medicine, Hospital of the Brothers of St. John of God (Krankenhaus Barmherzige Brüder) Salzburg, Salzburg, Austria
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24
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Boman KK, Lannering B, von Essen L, Jarfelt M. Generalizing approaches to surveillance for complex social outcomes in broad-range patient populations-The cost in terms of lost information and subgroup utility. Cancer 2022; 128:2400-2404. [PMID: 35435237 DOI: 10.1002/cncr.34214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Krister K Boman
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Birgitta Lannering
- Pediatric Oncology, Department of Pediatrics, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marianne Jarfelt
- Department of Oncology, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden.,Follow-Up Clinic for Adult Childhood Cancer Survivors and Cancer Rehabilitation, Sahlgrenska University Hospital, Gothenburg, Sweden
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25
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Mulrooney DA. Challenges Predicting the Cardiovascular Future for Survivors of Childhood Cancer. Cancer Epidemiol Biomarkers Prev 2022; 31:515-517. [PMID: 35253045 DOI: 10.1158/1055-9965.epi-21-1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease (CVD) risk stratification relies on assessment of nonmodifiable (age, sex, family history) and modifiable (weight, tobacco, physical activity, blood pressure, glucose/lipid levels) risk factors. Cancer therapy, itself a potential risk factor, may alter metabolism in long-term survivors of childhood cancer resulting in premature acquisition of age-related modifiable CVD risk factors. For survivors exposed to cardiotoxic therapies, the risk for CVD is significantly augmented by obesity, diabetes, dyslipidemia, and hypertension. An understanding of these risks may not be well communicated as survivors return to primary care and general population screening practices may be insufficient. Lipshultz and colleagues recruited childhood cancer survivors to return to their treating institution for a comprehensive clinical assessment. Interestingly, compared with a noncancer age-, sex-, and race/ethnicity-matched National Health and Nutrition Examination Survey population, cardiometabolic profiles were largely similar. However, cancer survivors had a higher prevalence of prehypertension/hypertension (38.4% vs. 30.1%, P = 0.04) and a lower prevalence of the metabolic syndrome (11.9% vs. 18.7%, P = 0.05). Applying general population CVD risk calculators and a cancer-specific model from the Childhood Cancer Survivor Study, risk estimates were notably higher when cardiotoxic cancer treatment exposures were included. See related article by Lipshultz et al., p. 536.
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Affiliation(s)
- Daniel A Mulrooney
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Departments of Pediatrics and Medicine, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
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