Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: Retrospective analysis of the childhood cancer survivor study cohort Journal Article


Authors: Mulrooney, D. A.; Yeazel, M. W.; Kawashima, T.; Mertens, A. C.; Mitby, P.; Stovall, M.; Donaldson, S. S.; Green, D. M.; Sklar, C. A.; Robison, L. L.; Leisenring, W. M.
Article Title: Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: Retrospective analysis of the childhood cancer survivor study cohort
Abstract: Objectives: To assess the incidence of and risks for congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities among adult survivors of childhood and adolescent cancers. Design: Retrospective cohort study. Setting: 26 institutions that participated in the Childhood Cancer Survivor Study. Participants: 14 358 five year survivors of cancer diagnosed under the age of 21 with leukaemia, brain cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma, kidney cancer, neuroblastoma, soft tissue sarcoma, or bone cancer between 1970 and 1986. Comparison group included 3899 siblings of cancer survivors. Main outcome measures: Participants or their parents (in participants aged less than 18 years) completed a questionnaire collecting information on demographic characteristics, height, weight, health habits, medical conditions, and surgical procedures occurring since diagnosis. The main outcome measures were the incidence of and risk factors for congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities in survivors of cancer compared with siblings. Results: Survivors of cancer were significantly more likely than siblings to report congestive heart failure (hazard ratio (HR) 5.9, 95% confidence interval 3.4 to 9.6; P<0.001), myocardial infarction (HR 5.0, 95% CI 2.3 to 10.4; P<0.001), pericardial disease (HR 6.3, 95% CI 3.3 to 11.9; P<0.001), or valvular abnormalities (HR 4.8, 95% CI 3.0 to 7.6; P<0.001). Exposure to 250 mg/m2 or more of anthracyclines increased the relative hazard of congestive heart failure, pericardial disease, and valvular abnormalities by two to five times compared with survivors who had not been exposed to anthracyclines. Cardiac radiation exposure of 1500 centigray or more increased the relative hazard of congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities by twofold to sixfold compared to nonirradiated survivors. The cumulative incidence of adverse cardiac outcomes in cancer survivors continued to increase up to 30 years after diagnosis. Conclusion: Survivors of childhood and adolescent cancer are at substantial risk for cardiovascular disease. Healthcare professionals must be aware of these risks when caring for this growing population.
Keywords: adolescent; adult; child; controlled study; school child; leukemia; cancer surgery; major clinical study; clinical trial; cisplatin; cancer radiotherapy; radiation dose; outcome assessment; incidence; cyclophosphamide; vincristine; risk factor; childhood cancer; radiation exposure; cancer survivor; questionnaire; nonhodgkin lymphoma; adverse outcome; medical information; neuroblastoma; cardiovascular disease; cardiovascular risk; heart infarction; multicenter study; soft tissue sarcoma; bleomycin; health care personnel; brain cancer; sibling; anthracycline; congestive heart failure; drug exposure; bone cancer; parent; pericardial disease; population growth; valvular heart disease
Journal Title: BMJ: British Medical Journal (International Edition)
Volume: 340
Issue: 7736
ISSN: 0959-8146
Publisher: BMJ Publishing Group Ltd.  
Date Published: 2010-01-02
Start Page: 34
Language: English
DOI: 10.1136/bmj.b4606
PROVIDER: scopus
PMCID: PMC3266843
PUBMED: 19996459
DOI/URL:
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: BMJOA" - "Source: Scopus"
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  1. Charles A Sklar
    276 Sklar