Abstract
The evolution of cancer therapies has led to marked improvement in survival of those affected by childhood malignancies, while also increasing the recognition of early and late toxicities associated with cancer therapies. Cardiotoxicity can include cardiomyopathy/heart failure, coronary artery disease, stroke, pericardial disease, arrhythmias, and valvular and vascular dysfunction as a result of exposure to chemotherapy and/or radiation. Anthracyclines remain the most common cause of chemotherapy-induced cardiomyopathy (CCM) with varying clinical presentations including: acute, early onset, and late-onset. Many individuals develop cardiac dysfunction over the long-term, ranging from subclinical cardiac dysfunction to end-stage symptomatic heart failure. The focus of this review is on characterization of symptomatic heart failure in children with cancer therapy-related cardiac dysfunction (CTRCD) primarily due to CCM and utilization of advanced heart failure therapies, including ventricular assist device (VAD) support and heart transplantation, with consideration of unique patient-related factors.
Highlights
The evolution of cancer therapies has led to marked improvement in survival of those affected by childhood malignancies
The Childhood Cancer Survivor Study (CCSS), a study following a cohort of survivors who were treated from 1970–1986 and had survived at least five years after treatment, has shown that survivors were found to have an increased relative risk of a chronic health condition compared to their siblings of 3.3 [6]
Predictors of myocardial recovery are not well understood, early implementation of left ventricular assist device (LVAD) therapy for decompensated heart failure combined with optimal use of neurohormonal blockade and other reverse remodeling therapies is likely to be instrumental in preventing irreversible cardiac damage from chemotherapeutic agents
Summary
The evolution of cancer therapies has led to marked improvement in survival of those affected by childhood malignancies. The five-year survival in children and adolescents with cancer ranged from 58–68% in the 1970s to 84–85% during the 2010–2016 time frame [1,2]. This trend has resulted in increased recognition of the early and late toxicities associated with cancer therapies. The cardiotoxic effects of anti-cancer therapies are broad and variable in onset including cardiomyopathy/heart failure, coronary artery disease, stroke, pericardial disease, arrhythmias, and valvular and vascular dysfunction [3,4,5].
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