Long-Term Cardiovascular Outcomes in Childhood Cancer Survivors: A Systematic Review

Abstract

In recent years, childhood cancer appears to have become more common. Cardiovascular (CV) diseases have been cited as the leading cause of noncancer mortality among childhood cancer survivors. This systematic review evaluated the long-term CV outcomes of childhood cancer survivors. Eleven studies, published between 2015 and 2024 that satisfied the criteria for a thorough assessment, are included in the study. The research found consistent associations between specific cancer treatments, such as anthracyclines, radiation therapy, and total body irradiation, and increased risks of cardiomyopathy, coronary artery disease, and metabolic syndrome. Hematological malignancies, such as childhood acute lymphoblastic leukemia, and survivors of solid tumors like prostate and lung cancers were more specifically associated with CV complications. Although factors like obesity, hypertension, and insulin resistance were commonly reported, discrepancies based on race and gender were diverse across studies. Case in point, cardiometabolic challenges were more prevalent among non-Hispanic Black and Hispanic survivors, but these patterns were not uniform in all cohorts. Comparably, vulnerabilities such as peripartum cardiomyopathy were more evident in female survivors, particularly at younger ages and with higher anthracycline doses. These findings underscore both consistent and variable patterns of CV risks among childhood cancer survivors. The threats are influenced by the kind of cancer, the type of therapy, and demographic factors such as age, gender, and ethnicity. Thus, there is a need to put in place systematic, lifelong programs for cardiometabolic screening and risk reduction that are tailored to each person's risk profile. These programs should include echocardiography, regular serum biomarker testing, lifestyle modifications (exercise, nutrition), and psychosocial support.

Keywords: ambulatory blood pressure monitoring; cardiovascular disease; cardiovascular risk factors (cvrf); graft-versus-host disease; hematopoietic stem cell transplantation (hsct).

Figure 1. PRISMA flow diagram

PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses

Figure 2. Summary of studies’ risk of bias of each item

Scores were interpreted as follows: 0-2 indicated a high risk of bias, 3-4 a moderate risk, and 5-7 a low risk of bias.

Figure 3. Summary of each study’s risk of bias for each item

Based on the reviewers’ evaluation of the study items’ risk of bias, the risk-of-bias summary displays red circles for high risk, green circles for low risk, and white circles for uncertain risk.

Figure 4. Funnel plot depicting publication bias

x-axis: standard error; y-axis: effect size CVD, cardiovascular disease; RR, relative risk; SE, standard error