Cardiovascular disease in Adult Life after Childhood Cancer in Scandinavia: A population‐based cohort study of 32,308 one‐year survivors

Abstract

The lifetime risk for cardiovascular disease in a large cohort of childhood cancer survivors has not been fully assessed. In a retrospective population-based cohort study predicated on comprehensive national health registers, we identified a cohort of 32,308 one-year survivors of cancer diagnosed before the age of 20 in the five Nordic countries between the start of cancer registration in the 1940s and 1950s to 2008; 211,489 population comparison subjects were selected from national population registers. Study subjects were linked to national hospital registers, and the observed numbers of first hospital admission for cardiovascular disease among survivors were compared with the expected numbers derived from the population comparison cohort. Cardiovascular disease was diagnosed in 2,632 childhood cancer survivors (8.1%), yielding a standardized hospitalization rate ratio (RR) of 2.1 (95% CI 2.0-2.2) and an overall absolute excess risk (AER) of 324 per 100,000 person-years. At the end of follow-up 12% of the survivors were 50 years of age and 4.5% 60 years of age. Risk estimates were significantly increased throughout life, with an AER of~500-600 per 100,000 person-years at age 40. The highest relative risks were seen for heart failure (RR, 5.2; 95% CI 4.5-5.9), valvular dysfunction (4.6; 3.8-5.5) and cerebrovascular diseases (3.7; 3.4-4.1). Survivors of hepatic tumor, Hodgkin lymphoma and leukemia had the highest overall risks for cardiovascular disease, although each main type of childhood cancer had increased risk with different risk profiles. Nordic childhood cancer survivors are at markedly increased risk for cardiovascular disorders throughout life. These findings indicate the need for preventive interventions and continuous follow-up for this rapidly growing population.

Cellular senescence in aging and age-related disease: from mechanisms to therapy

“…In this procedure, the patient’s immune system is ablated by ionizing radiation or chemotherapy, which, as an unwanted side effect, creates a senescent cell–rich milieu that might not only impair the engraftment and functionality of the hematopoietic system of the healthy donor 141,142 , but also accelerate tissue deterioration at a systemic level. Consistent with this, survivors of pediatric cancer who have gone through such treatments exhibit signs of premature aging 143 , including loss of cognitive function 144 and heart failure 145 , with precocious elevation of p16 Ink4a in skin 49 .…”

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

“…Z największym łącznym ryzykiem CVD wiązało się leczenie raka wą-troby, chłoniaka Hodgkina i białaczek, a najczęstszymi problemami były kolejno: HF [ryzyko względne (RR) 5,2; 95% przedział ufności (CI) 4,5-5,9], dysfunkcja zastawki (RR 4,6; 95% CI 3,8-5,5) oraz choroba naczyniowo-mó-zgowa (RR 3,7; 95% CI 3,4-4,1). W porównaniu z grupą kontrolną ryzyko dowolnej CVD wykazywało znaczną zmienność, z prawie 20-krotnym wzrostem ryzyka wśród młodych pacjentów w porównaniu z ryzykiem względnym wynoszącym zaledwie 1,3 wśród osób po przebytym nowotworze w wieku > 60 lat, co wynika z następującego wraz z wiekiem znacznego wzrostu zapadalności na CVD niezwiązanego z nowotworem [217]. W ostatnio opublikowanych ujednoliconych międzynarodowych wytycznych zalecono dożywotnią obserwację pacjentów po przebytym leczeniu przeciwnowotworowym w dzieciństwie, u których stosowano antracykliny, radioterapię z użyciem dużych dawek obejmujących klatkę piersiową lub obie te metody terapii [91,92].…”

Risk of cardiovascular disease among Nordic childhood cancer survivors with diabetes mellitus: A report from adult life after childhood cancer in Scandinavia

“…This increase in risk is seen throughout the follow-up. 5,6 Notably, we show that the increase in risk for CVD among survivors was higher the first 15 years after the cancer diagnosis, although it was still almost 2-fold after 15 or more years. In this cohort, 1-year survivors had a 1.7 times increased risk of diabetes in comparison with the general population, and this is in accordance with earlier reports.…”

“…1 However, these advances in treatment and survival come at a price, and many survivors face an increased risk for a broad range of treatment-induced sequelae, most of which become clinically apparent many years after the children have been cured. [4][5][6][7][8] Previous research has also shown that childhood cancer survivors have an increased risk for diabetes mellitus. [4][5][6][7][8] Previous research has also shown that childhood cancer survivors have an increased risk for diabetes mellitus.…”