Childhood cancer treatment may increase cardiac dysfunction risk in adulthood
MedWire News: A Dutch study reports that childhood cancer survivors (CCSs) have an increased risk for abnormal cardiac function in early adulthood.
"The most important risk factors for developing subclinical cardiac dysfunction are the cumulative anthracycline dose, radiotherapy to the thorax, and younger age at diagnosis," say Helen van der Pal (Emma's Children's Hospital/Academic Medical Center, Amsterdam) and team.
Between January 1996 and April 2004, the researchers assessed the left ventricular (LV) function of 601 adult CCSs (≥5 years survival) who had received cancer treatment with a potentially cardiotoxic agent between January 1966 and August 1997.
Patients with a history of anthracycline, high-dose cyclophosphamide, cardiac irradiation, or high-dose ifosfamide (n=525) also underwent echocardiography, with 514 of these patients evaluated further for LV shortening fraction (LVSF).
The team found a median shortening fraction of 33.1%, with subclinical cardiac dysfunction, defined as LVSF <30%, present in 27% of the patients.
Further analysis revealed that the risk for subclinical cardiac dysfunction increased as age at diagnosis decreased, with a 1.45, 1.64, and 2.94-fold risk increase among patients diagnosed at 10-15 years, 5-10 years, and <5 years, respectively (all p=0.049), compared with those diagnosed at >15 years.
Similarly, patients who received radiation to the thorax had a 3.49-fold increase in subclinical cardiac dysfunction risk compared with those who received no radiation.
Patients with a history of combination therapy with anthracycline plus cyclophosphamide or ifosfamide had a higher rate of subclinical cardiac dysfunction than any other individual or combination treatment, at 34.1%.
Of note, daunorubicin was the only anthracycline that did not increase subclinical cardiac dysfunction risk.
The researchers also found that cumulative anthracycline dose positively correlated with the risk for subclinical cardiac dysfunction, with a 10.58-fold risk increase for a cumulative dose of >450 mg/m2 compared with a dose of 1-150 mg/m2 (p<0.001).
This trend was not observed for cyclophosphamide or ifosfamide therapy, however.
Writing in the Archives of Internal Medicine, van der Pal et al conclude: "Continued monitoring of all childhood cancer survivors treated with potentially cardiotoxic therapy with or without subclinical cardiac dysfunction is necessary to identify childhood cancer survivors who could possibly benefit from early treatment, which could avoid further deterioration of cardiac function."
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By Lauretta Ihonor