Cancer and Cardiac Mortality Among 15-Year Survivors of Cancer Diagnosed During Childhood or Adolescence

Green, Daniel M.; Hyland, Andrew; Chung, Chiung-Yin; Zevon, Michael A.; Hall, Brenda

doi:10.1200/jco.1999.17.10.3207

Cited by 112 publications

(51 citation statements)

References 35 publications

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“…[10][11][12] Previous studies have found elevated risks for chronic health conditions which contribute to higher mortality among survivors of childhood cancer patients compared to the general population. 5,9,13,14 Patterns of increased excess mortality after childhood cancer have been shown to be dependent on time from cancer diagnosis and cause of death. 4,7,11 The success of improved cancer survival is overshadowed by the life-threatening chronic health outcomes that cancer survivors are more likely to suffer from.…”

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confidence: 99%

Late mortality among 5‐year survivors of early onset cancer: A population‐based register study

Kero

Järvelä

Arola

et al. 2014

Intl Journal of Cancer

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To date, only few studies have been published documenting late mortality among early onset cancer survivors, especially regarding young adulthood (YA) malignancies. Our nation-wide population-based registry study provides information concerning cause-specific long-term mortality among 16,769 5-year survivors of early onset cancer (aged 0-34 years at diagnosis), with follow-up for death extending from 1971 through 2012. A sibling cohort and population data were used as reference. The overall standardized mortality ratio (SMR) of cancer patients was 4.6-fold, (95% CI 4.4-4.8). Highest SMRs were found for malignancies (12.8,3), infectious (4.8, 95%CI 2.9-6.7) and cardiovascular diseases (1.9, 95% CI 1.7-2.1). Malignancies and cardiovascular diseases accounted for the largest number of deaths. Childhood and YA cancer survivors with the same primary cancer site had a similarly elevated overall SMR with the exception of markedly higher SMRs after childhood Hodgkin lymphoma. The highest cumulative non-malignancy-related mortality was due to cardiovascular disease with a steady rise throughout the follow-up, but strongly dependent on the primary cancer site and age at diagnosis. In childhood cancer survivors, the cumulative cardiovascular mortality did not reduce over time. However, overall and malignancyrelated mortality showed a declining tendency towards the most recent periods after both, childhood and YA cancer. Our findings on non-malignancy-related mortality stress the need to set up long-term individual follow-up with a focus on cardiovascular late effects for early onset cancer survivors, especially for YA cancer survivors still lacking those.Advances in therapies for early onset cancer have lead to a substantial increase in 5-year survival rates. 1-3 Thus far the main focus of late effect research has been on the morbidity and mortality of childhood cancer survivors aged up to 21 years at cancer diagnosis. [4][5][6][7][8][9] Only few studies have investigated those topics for the survivors of young adult (YA) cancer patients aged from 20 to 34 years at cancer diagnosis. [10][11][12] Previous studies have found elevated risks for chronic health conditions which contribute to higher mortality among survivors of childhood cancer patients compared to the general population. 5,9,13,14 Patterns of increased excess mortality after childhood cancer have been shown to be dependent on time from cancer diagnosis and cause of death. 4,7,11 The success of improved cancer survival is overshadowed by the life-threatening chronic health outcomes that cancer survivors are more likely to suffer from. Thus, the growing population of early onset cancer survivors has a strong need for adequate individualized follow-up to detect and possibly reduce treatment-related morbidities and mortality. 15 After the survival of childhood cancer, the adoption of a healthy lifestyle including physical activity may lower especially the risk of developing late cardiovascular sequelae. 16 Thus, promoting the control of known cardiovascular risk fa...

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confidence: 99%

Late mortality among 5‐year survivors of early onset cancer: A population‐based register study

Kero

Järvelä

Arola

et al. 2014

Intl Journal of Cancer

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“…In children heart and lung disorders are one of the three main causes of death [8]. The recurrence of primary disease and secondary malignancies are the two most common causes among childhood cancer survivors [9]. Cardiac dysfunction may present as myocardial dysfunction, myocarditis, congestive cardiac failure, arrhythmias, valvular dysfunction and accelerated risk of myocardial dysfunction in later life.…”

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confidence: 99%

Incidence of Cardiotoxicity in Treated Cases of Paediatric Hodgkin Lymphoma

Rehman¹,

Riaz²

2017

HTIJ

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“…4,5 It is now clear that adult survivors of childhood cancer face excessive cardiovascular morbidity and mortality. [6][7][8][9][10][11][12] The increased cardiovascular morbidity is correlated with several defined risk factors, including cumulative lifetime anthracycline dose, concomitant radiation therapy, the use of other cardiotoxic medications, genetic predispositions, and other as yet incompletely defined factors. In an effort to minimize cardiotoxicity, routine monitoring of individuals treated with these agents is used before, during, and after treatment.…”

Section: Introductionmentioning

confidence: 99%

Pretreatment and routine echocardiogram monitoring during chemotherapy for anthracycline‐induced cardiotoxicity rarely identifies significant cardiac dysfunction or alters treatment decisions

Watts

George

Johnson

2011

Cancer

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BACKGROUND:The widespread use of anthracycline chemotherapy has contributed to improved outcomes in children with cancer. The most feared complication of the anthracyclines is cardiotoxicity. Routine echocardiographic monitoring typically is used before, during, and after treatment to minimize cardiotoxicity. The ideal use of screening before and during chemotherapy remains uncertain. METHODS: This was a retrospective review of children who were treated at a single cancer treatment center over 5 years. The results of all echocardiograms and related clinical decisions were reviewed. RESULTS: In 356 patients who were identified for review (age range, 3 months to 22 years; mean age, 10 years; median age, 11 years), 991 echocardiograms were reviewed (average, 2.78 echocardiograms per patient; median, 2 echocardiograms per patient; mode, 1; maximum, 11 echocardiograms per patient). Nine abnormal echocardiograms were identified (2.5% of patients and 0.9% of echocardiograms performed). Four echocardiograms were performed during episodes of septic shock, 2 echocardiograms represented false-positive studies after repeat evaluation, and 1 echocardiogram demonstrated mild abnormality of function on the day of surgical resection of a large Wilms tumor. None of the 356 pretreatment echocardiograms altered treatment decisions. In 635 follow-up echocardiograms during treatment, cardiac defects were detected in 2 patients (0.5%). CONCLUSIONS: The routine use of echocardiograms to screen for anthracycline-induced cardiac damage before and during chemotherapy rarely identified significant cardiac damage to impact treatment decisions. Improved screening techniques with better discrimination and predictability are needed. Pediatric Oncology cooperative groups should consider a revision of standard monitoring protocols before and during treatment.

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Cancer and Cardiac Mortality Among 15-Year Survivors of Cancer Diagnosed During Childhood or Adolescence

Cited by 112 publications

References 35 publications

Late mortality among 5‐year survivors of early onset cancer: A population‐based register study

Late mortality among 5‐year survivors of early onset cancer: A population‐based register study

Incidence of Cardiotoxicity in Treated Cases of Paediatric Hodgkin Lymphoma

Pretreatment and routine echocardiogram monitoring during chemotherapy for anthracycline‐induced cardiotoxicity rarely identifies significant cardiac dysfunction or alters treatment decisions

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