Chapter 27 - Cardiotoxicity of Childhood Cancer Treatments

Abstract

The improvement in diagnostic methods and the new therapeutic modalities among pediatric patients suffering from cancer have led to increasing survival rates in the last years. Nonetheless, although anticancer therapies are steadily improving in terms of safety and tolerance, long-term cancer survivors are still at high risk of developing health impairments, which may result in life-threatening conditions related to therapy side effects. Development of secondary malignancies and cardiac disturbances are the most common side effects described in childhood cancer survivors. In these children, there is a higher risk of major cardiac events such as coronary artery disease, heart valve disease, cardiomyopathy, and heart failure as compared to a control group of siblings. This increased burden of cardiovascular disease could be explained by direct toxicity of the treatment, affecting the function and structure of the heart, or by a faster development of coronary vascular disease, especially if other individual or environmental risk factors are associated. There is a growing number of patients surviving childhood cancer exposed to potential cardiovascular morbidity and mortality. Thus, understanding the underlying factors and prevention options regarding long-term cardiovascular side effects is essential for accurate detection and management of these possible life-threatening events. This chapter describes succinctly the epidemiology of malignancies among children and is especially focused on long-term cardiovascular side effects of cancer therapy. As there is a myriad of possible cardiac complications, this section will summarize the most important ones, emphasizing the risk factors associated with each of the impairments and the diagnostic and prevention options available.