Adult survivors of childhood and adolescent cancer have more heart disease

Abstract

Survivors of childhood and adolescent cancers have a significantly higher risk of developing problems such as heart failure, heart attacks, inflammation of the heart, and heart valve abnormalities as late as 30 years after receiving their cancer therapy, according to research from the University of Minnesota in Minneapolis. The study, led by Daniel Mulrooney, MD, also found that the risk occurs at lower levels of exposure to anthracyclines and radiation than previously thought.1 Dr. Mulrooney and colleagues caution healthcare providers to be aware of these increased risks when caring for childhood cancer survivors. The study compared 14,358, 5-year cancer survivors from the Childhood Cancer Survivor Study with 3899 siblings of cancer survivors. The cancer survivors were all diagnosed before age 21 years between 1970 and 1986. Their cancers included leukemia, brain cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, kidney cancer, neuroblastoma, soft tissue sarcoma, and bone cancer. Participants or their parents filled out questionnaires about their health, medical conditions, and surgical procedures since diagnosis. The cancer survivors were at significantly higher risk of developing cardiac problems. Those who had been treated with chemotherapy had a 2 to 5 times higher risk than those who had no chemotherapy. Radiation exposure increased the risk by 2 to 6 times compared with those who had not had radiotherapy. Young adults are clearly at risk for early cardiac morbidity and mortality that is not generally clinically followed in their age group; therefore, they require ongoing monitoring, Dr. Mulrooney notes. In a related development, a recent review urged cardiologists and oncologists to work together to prevent adverse cardiovascular effects from certain chemotherapies, especially in patients who may be high risk for these effects.2 The review addressed an aging population that is more likely to have both cancer and cardiovascular disease. In a review of literature, Adriana Albini, PhD, chief of oncology research of the Clinical and Research Institute Multi- Medica, in Milan, Italy, and others summarized the potential cardiovascular toxicities from a range of chemotherapeutic and chemopreventive agents and noted the importance of evaluating cardiovascular risk before patients are treated. They stressed the need to develop guidelines and a new interdisciplinary field, “cardio-oncology.” New biomarkers and imaging techniques may help identify high-risk patients, they note. Clinical trials assessing the choice of therapy and agents that prevent cardiotoxicity would be useful, as would assessment of cardiotoxicity in phase 1 trials to develop new agents with less risk, the authors add. They conclude that oncologists should not only be fully aware of cardiovascular risks but also that cardiologists must assist oncologists by performing evaluations relevant to the choice of therapy.