Individual prediction of heart failure among childhood cancer survivors Journal Article


Authors: Chow, E. J.; Chen, Y.; Kremer, L. C.; Breslow, N. E.; Hudson, M. M.; Armstrong, G. T.; Border, W. L.; Feijen, E. A. M.; Green, D. M.; Meacham, L. R.; Meeske, K. A.; Mulrooney, D. A.; Ness, K. K.; Oeffinger, K. C.; Sklar, C. A.; Stovall, M.; Van Der Pal, H. J.; Weathers, R. E.; Robison, L. L.; Yasui, A. Y.
Article Title: Individual prediction of heart failure among childhood cancer survivors
Abstract: Purpose: To create clinically useful models that incorporate readily available demographic and cancer treatment characteristics to predict individual risk of heart failure among 5-year survivors of childhood cancer. Patients and Methods: Survivors in the Childhood Cancer Survivor Study (CCSS) free of significant cardiovascular disease 5 years after cancer diagnosis (n = 13,060) were observed through age 40 years for the development of heart failure (ie, requiring medications or heart transplantation or leading to death). Siblings (n = 4,023) established the baseline population risk. An additional 3,421 survivors from Emma Children's Hospital (Amsterdam, the Netherlands), the National Wilms Tumor Study, and the St Jude Lifetime Cohort Study were used to validate the CCSS prediction models. Results: Heart failure occurred in 285 CCSS participants. Risk scores based on selected exposures (sex, age at cancer diagnosis, and anthracycline and chest radiotherapy doses) achieved an area under the curve of 0.74 and concordance statistic of 0.76 at or through age 40 years. Validation cohort estimates ranged from 0.68 to 0.82. Risk scores were collapsed to form statistically distinct low-, moderate-, and high-risk groups, corresponding to cumulative incidences of heart failure at age 40 years of 0.5% (95% CI, 0.2% to 0.8%), 2.4% (95% CI, 1.8% to 3.0%), and 11.7% (95% CI, 8.8% to 14.5%), respectively. In comparison, siblings had a cumulative incidence of 0.3% (95% CI, 0.1% to 0.5%). Conclusion: Using information available to clinicians soon after completion of childhood cancer therapy, individual risk for subsequent heart failure can be predicted with reasonable accuracy and discrimination. These validated models provide a framework on which to base future screening strategies and interventions.
Keywords: adult; child; major clinical study; doxorubicin; cancer radiotherapy; comparative study; outcome assessment; cancer diagnosis; sensitivity analysis; demography; disease association; incidence; cohort analysis; cancer therapy; prediction; childhood cancer; cancer survivor; cardiovascular risk; heart failure; population risk; mitoxantrone; daunorubicin; epirubicin; idarubicin; high risk population; sibling; low risk population; human; male; female; priority journal; article; moderate risk population
Journal Title: Journal of Clinical Oncology
Volume: 33
Issue: 5
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2015-02-10
Start Page: 394
End Page: 402
Language: English
DOI: 10.1200/jco.2014.56.1373
PROVIDER: scopus
PMCID: PMC4314592
PUBMED: 25287823
DOI/URL:
Notes: Export Date: 2 March 2015 -- Source: Scopus
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MSK Authors
  1. Charles A Sklar
    298 Sklar
  2. Kevin Oeffinger
    280 Oeffinger