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Multicenter Study
. 2009 Dec 8:339:b4606.
doi: 10.1136/bmj.b4606.

Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort

Daniel A Mulrooney  1 , Mark W Yeazel, Toana Kawashima, Ann C Mertens, Pauline Mitby, Marilyn Stovall, Sarah S Donaldson, Daniel M Green, Charles A Sklar, Leslie L Robison, Wendy M Leisenring
Affiliations
Multicenter Study

Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort

Daniel A Mulrooney et al. BMJ. .

Abstract

Objectives: To assess the incidence of and risks for congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities among adult survivors of childhood and adolescent cancers.

Design: Retrospective cohort study.

Setting: 26 institutions that participated in the Childhood Cancer Survivor Study.

Participants: 14,358 five year survivors of cancer diagnosed under the age of 21 with leukaemia, brain cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma, kidney cancer, neuroblastoma, soft tissue sarcoma, or bone cancer between 1970 and 1986. Comparison group included 3899 siblings of cancer survivors.

Main outcome measures: Participants or their parents (in participants aged less than 18 years) completed a questionnaire collecting information on demographic characteristics, height, weight, health habits, medical conditions, and surgical procedures occurring since diagnosis. The main outcome measures were the incidence of and risk factors for congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities in survivors of cancer compared with siblings.

Results: Survivors of cancer were significantly more likely than siblings to report congestive heart failure (hazard ratio (HR) 5.9, 95% confidence interval 3.4 to 9.6; P<0.001), myocardial infarction (HR 5.0, 95% CI 2.3 to 10.4; P<0.001), pericardial disease (HR 6.3, 95% CI 3.3 to 11.9; P<0.001), or valvular abnormalities (HR 4.8, 95% CI 3.0 to 7.6; P<0.001). Exposure to 250 mg/m(2) or more of anthracyclines increased the relative hazard of congestive heart failure, pericardial disease, and valvular abnormalities by two to five times compared with survivors who had not been exposed to anthracyclines. Cardiac radiation exposure of 1500 centigray or more increased the relative hazard of congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities by twofold to sixfold compared to non-irradiated survivors. The cumulative incidence of adverse cardiac outcomes in cancer survivors continued to increase up to 30 years after diagnosis.

Conclusion: Survivors of childhood and adolescent cancer are at substantial risk for cardiovascular disease. Healthcare professionals must be aware of these risks when caring for this growing population.

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Conflict of interest statement

Competing interests: None declared.

Figures

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Fig 1 Flow chart of participation in the Childhood Cancer Survivor Study cohort. *Includes participants who also responded to the follow-up questionnaire (2000-2; n=10 367)
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Fig 2 Cumulative incidence and 95% CI of cardiac disorders among childhood cancer survivors
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Fig 3 Cumulative incidence of cardiac disorders among childhood cancer survivors by anthracycline dose
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Fig 4 Cumulative incidence of cardiac disorders among childhood cancer survivors by average cardiac radiation dose
See this image and copyright information in PMC

Comment in

  • Survivors of childhood cancer.
    Jenney M, Levitt G. Jenney M, et al. BMJ. 2009 Dec 8;339:b4691. doi: 10.1136/bmj.b4691. BMJ. 2009. PMID: 19996460 No abstract available.

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