In this Podcast, Professor Leontien Kremer, MD of the Princess Máxima Center, along with PHd candidates Dr.Esmee C. de Baat of the Princess Máxima Center, Dr. Jan M. Leeink of the Amsterdam University Medical Centers, and Dr. Remy Merkx of the Radboud University Medical Center discuss Cardiac Disease in Childhood Cancer Survivors and Risk Prediction, Prevention, and Surveillance.
Link to Abstract-
Cardiac disease is a key issue among the expanding population of pediatric cancer survivors. Cardiotoxicity caused by anthracyclines and chest irradiation is still a topic of discussion in today's medical world. Evidence on traditional cardiovascular risk factors in childhood cancer survivors is growing, and mitoxantrone has emerged as an important treatment-related risk factor. The goal of developing international monitoring recommendations is to detect and manage heart illnesses early and prevent symptomatic disease. Risk prediction algorithms are gaining popularity as a way to personalize prevention and surveillance. This State-of-the-Art Review compiles findings from a comprehensive PubMed search on cardiac problems following children cancer treatment. The prevalence, risk factors, prevention, risk prediction, and surveillance of cardiac disorders in pediatric cancer survivors are discussed here.
• Anthracyclines, mitoxantrone, and the dose of chest-directed radiation are the key risk factors for heart illness in childhood cancer survivors.
• Using primary prevention techniques, the risk of anthracycline-induced cardiomyopathy may be reduced.
• Traditional cardiovascular risk factors are more prevalent in pediatric cancer survivors; screening and early care are critical to reducing risk.
• Multivariable risk prediction models could aid in the personalization of preventative and surveillance plans.
Children's cancer survival rates have grown dramatically in recent decades, with 5-year survival rates now above 80%. (1). Long-term health repercussions in the expanding population of childhood cancer survivors (CCS) remain, nevertheless, a major source of concern (2). Cardiac disease caused by anthracyclines, mitoxantrone, and/or chest-directed radiotherapy (chest RT) can manifest as myocardial dysfunction and heart failure, but it can also manifest as valvular disease, coronary artery disease, arrhythmias, and pericardial disease, depending on the specific cardiotoxic agent (3).
We focus on long-term cardiac problems after children cancer therapy in this State-of-the-Art Review. In this population, we cover the prevalence, risk factors, prevention, prediction, and surveillance of heart illness (Central Illustration). We conducted a systematic search of PubMed for articles describing cardiac side effects in children receiving cardiotoxic cancer therapies. We restricted our search to full-text English-language papers published during the last ten years. We chose publications having a research cohort in which more than half of the participants had been treated for pediatric cancer before the age of 21. We looked for studies with a minimum of 500 CCS for studies describing the prevalence or cumulative incidence of heart failure, and a minimum of 100 CCS for the other outcomes. Previous Cochrane searches (4–6) turned up studies on primary preventive measures. 74 studies were selected to be described in this review based on these criteria (Figure 1). Supplementary Table 1 contains the whole search strategy.