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Cardiovascular Disease in Adult Survivors of Childhood and Adolescent Cancer: A Report from the Childhood Cancer Survivor Study (CCSS)
Sarah S. Donaldson, Stanford University Medical Center
Keywords: Childhood Cancer, Survivors, Cardiovascular disease
Background: Previous research has shown that cardiovascular disease contributes to significant morbidity and mortality among survivors of childhood and adolescent cancer. Few studies have reported risk factors in long-term survivors who are now adults.
Methods: This analysis includes 14,358 five-year cancer survivors of the CCSS diagnosed = age 21, between 1970-1986, with one of eight childhood cancers [leukemia, CNS tumors, Hodgkin (HD) or non-Hodgkin lymphomas (NHL), renal tumors, neuroblastoma, soft-tissue sarcomas (STS), bone cancers]. Self-reported cardiac outcomes occurring at least 5-years post-dx are compared to a sibling control group (N=3899) and across treatment groups using Cox proportional hazards models to estimate relative risks (RR) adjusted for age, gender, race, sociodemographic factors, and smoking status.
Results: Survivors (54% males) were on average 7.8 yrs (0-20) at diagnosis, and 27.5 yrs (8-51) at follow-up. Compared to siblings, survivors were more likely to report congestive heart failure (CHF) (RR 5.9 95% CI 3.4-9.6), myocardial infarction (MI) (RR 5.0 95% CI 2.3-10.4), atherosclerosis (RR 10.2 95% CI 3.7-28.3), pericardial (RR 6.3 95% CI 3.3-11.9) and valvular disease (RR 4.8 95% CI 3.0-7.6), and coronary angiography (RR 8.2 95% CI 4.2-16.1). Anthracycline exposure = 250 mg/m2 increased the risk of reported CHF (RR 5.2 95% CI 3.6-7.4), pericardial (RR 1.8 95% CI 1.1-3.0) and valvular disease (RR 2.3 95% CI 1.6-3.3), and angiography (RR 2.6 95% CI 1.8-3.7) compared to unexposed survivors. Radiation (RT) to the heart also increased the risk of CHF (RR 2.0 95% CI 1.4-2.8), MI (RR 1.9 95% CI 1.1-3.2), atherosclerosis (RR 5.3 95% CI 2.5-11.0), pericardial (RR 2.2 95% CI 1.4-3.3) and valvular disease (RR 2.8 95% CI 1.9-4.0), and angiography (RR 2.2 95% CI 1.5-3.2) compared to those survivors without cardiac directed RT.
Conclusion: The occurrence of premature cardiovascular diseases is substantial in this young adult population of cancer survivors.