Cardiac outcomes in adult survivors of childhood cancer exposed to cardiotoxic therapy

Daniel A. Mulrooney, Gregory Armstrong, Sujuan Huang, Kirsten K. Ness, Matthew J. Ehrhardt, Vijaya M. Joshi, Juan Carlos Plana, Elsayed Z. Soliman, Daniel M. Green, Deokumar Srivastava, Aimee Santucci, Matthew J. Krasin, Leslie L. Robison, Melissa M. Hudson

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Abstract

Background: Studies of cardiac disease among adult survivors of childhood cancer have generally relied on self-reported or registry-based data. Objective: To systematically assess cardiac outcomes among survivors of childhood cancer. Design: Cross-sectional study. Setting: St. Jude Children's Research Hospital. Patients: 1853 adult survivors of childhood cancer, aged 18 years or older, who received cancer-related cardiotoxic therapy at least 10 years earlier. Measurements: Baseline history and physical examination, fasting metabolic and lipid panels, echocardiography, electrocardiography, and 6-minute walk test. Results: One half of the survivors (52.3%) were men with a median age of 8 years (range, 0 to 24 years) at cancer diagnosis and 31 years (range, 18 to 60 years) at evaluation. Cardiomyopathy was present in 7.4% survivors (newly identified at the time of evaluation in 4.7%), coronary artery disease in 3.8% (newly identified in 2.2%), valvular regurgitation or stenosis in 28.0% (newly identified in 24.8%), and conduction or rhythm abnormalities in 4.4% (newly identified in 1.4%). Nearly all survivors were asymptomatic. The prevalence of cardiac conditions increased with age at evaluation, ranging from 3% to 24% among survivors aged 30 to 39 years to 10% to 37% among those aged 40 years or older. In multivariable analysis, survivors exposed to anthracycline doses of 250 mg/m2 or more had greater odds of cardiomyopathy (odds ratio, 2.7 [95% CI, 1.1 to 6.9]) than those who were not exposed. Survivors exposed to heart radiation also had increased odds of cardiomyopathy (odds ratio, 1.9 [CI, 1.1 to 3.7]) compared with those who were not exposed. Radiation exposure greater than 1500 cGy with any anthracycline exposure conferred the greatest odds for valve findings. Limitations: Sixty-one percent of survivors exposed to anthracycline chemotherapy or cardiac-directed radiation participated. A comparison group and longitudinal assessments were not available. Conclusion: Cardiovascular screening identified considerable subclinical disease among adult survivors of childhood cancer. Primary Funding Source: National Cancer Institute, American Lebanese Syrian Associated Charities.

Original languageEnglish (US)
Pages (from-to)93-101
Number of pages9
JournalAnnals of internal medicine
Volume164
Issue number2
DOIs
StatePublished - Jan 19 2016

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Survivors
Neoplasms
Anthracyclines
Cardiomyopathies
Therapeutics
Odds Ratio
Radiation
Charities
Second Primary Neoplasms
National Cancer Institute (U.S.)
Physical Examination
Registries
Echocardiography
Coronary Artery Disease
Heart Diseases
Fasting
Electrocardiography
Pathologic Constriction
Cross-Sectional Studies
History

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Mulrooney, D. A., Armstrong, G., Huang, S., Ness, K. K., Ehrhardt, M. J., Joshi, V. M., ... Hudson, M. M. (2016). Cardiac outcomes in adult survivors of childhood cancer exposed to cardiotoxic therapy. Annals of internal medicine, 164(2), 93-101. https://doi.org/10.7326/M15-0424

Cardiac outcomes in adult survivors of childhood cancer exposed to cardiotoxic therapy. / Mulrooney, Daniel A.; Armstrong, Gregory; Huang, Sujuan; Ness, Kirsten K.; Ehrhardt, Matthew J.; Joshi, Vijaya M.; Plana, Juan Carlos; Soliman, Elsayed Z.; Green, Daniel M.; Srivastava, Deokumar; Santucci, Aimee; Krasin, Matthew J.; Robison, Leslie L.; Hudson, Melissa M.

In: Annals of internal medicine, Vol. 164, No. 2, 19.01.2016, p. 93-101.

Research output: Contribution to journalArticle

Mulrooney, DA, Armstrong, G, Huang, S, Ness, KK, Ehrhardt, MJ, Joshi, VM, Plana, JC, Soliman, EZ, Green, DM, Srivastava, D, Santucci, A, Krasin, MJ, Robison, LL & Hudson, MM 2016, 'Cardiac outcomes in adult survivors of childhood cancer exposed to cardiotoxic therapy', Annals of internal medicine, vol. 164, no. 2, pp. 93-101. https://doi.org/10.7326/M15-0424
Mulrooney, Daniel A. ; Armstrong, Gregory ; Huang, Sujuan ; Ness, Kirsten K. ; Ehrhardt, Matthew J. ; Joshi, Vijaya M. ; Plana, Juan Carlos ; Soliman, Elsayed Z. ; Green, Daniel M. ; Srivastava, Deokumar ; Santucci, Aimee ; Krasin, Matthew J. ; Robison, Leslie L. ; Hudson, Melissa M. / Cardiac outcomes in adult survivors of childhood cancer exposed to cardiotoxic therapy. In: Annals of internal medicine. 2016 ; Vol. 164, No. 2. pp. 93-101.
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abstract = "Background: Studies of cardiac disease among adult survivors of childhood cancer have generally relied on self-reported or registry-based data. Objective: To systematically assess cardiac outcomes among survivors of childhood cancer. Design: Cross-sectional study. Setting: St. Jude Children's Research Hospital. Patients: 1853 adult survivors of childhood cancer, aged 18 years or older, who received cancer-related cardiotoxic therapy at least 10 years earlier. Measurements: Baseline history and physical examination, fasting metabolic and lipid panels, echocardiography, electrocardiography, and 6-minute walk test. Results: One half of the survivors (52.3{\%}) were men with a median age of 8 years (range, 0 to 24 years) at cancer diagnosis and 31 years (range, 18 to 60 years) at evaluation. Cardiomyopathy was present in 7.4{\%} survivors (newly identified at the time of evaluation in 4.7{\%}), coronary artery disease in 3.8{\%} (newly identified in 2.2{\%}), valvular regurgitation or stenosis in 28.0{\%} (newly identified in 24.8{\%}), and conduction or rhythm abnormalities in 4.4{\%} (newly identified in 1.4{\%}). Nearly all survivors were asymptomatic. The prevalence of cardiac conditions increased with age at evaluation, ranging from 3{\%} to 24{\%} among survivors aged 30 to 39 years to 10{\%} to 37{\%} among those aged 40 years or older. In multivariable analysis, survivors exposed to anthracycline doses of 250 mg/m2 or more had greater odds of cardiomyopathy (odds ratio, 2.7 [95{\%} CI, 1.1 to 6.9]) than those who were not exposed. Survivors exposed to heart radiation also had increased odds of cardiomyopathy (odds ratio, 1.9 [CI, 1.1 to 3.7]) compared with those who were not exposed. Radiation exposure greater than 1500 cGy with any anthracycline exposure conferred the greatest odds for valve findings. Limitations: Sixty-one percent of survivors exposed to anthracycline chemotherapy or cardiac-directed radiation participated. A comparison group and longitudinal assessments were not available. Conclusion: Cardiovascular screening identified considerable subclinical disease among adult survivors of childhood cancer. Primary Funding Source: National Cancer Institute, American Lebanese Syrian Associated Charities.",
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AU - Mulrooney, Daniel A.

AU - Armstrong, Gregory

AU - Huang, Sujuan

AU - Ness, Kirsten K.

AU - Ehrhardt, Matthew J.

AU - Joshi, Vijaya M.

AU - Plana, Juan Carlos

AU - Soliman, Elsayed Z.

AU - Green, Daniel M.

AU - Srivastava, Deokumar

AU - Santucci, Aimee

AU - Krasin, Matthew J.

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N2 - Background: Studies of cardiac disease among adult survivors of childhood cancer have generally relied on self-reported or registry-based data. Objective: To systematically assess cardiac outcomes among survivors of childhood cancer. Design: Cross-sectional study. Setting: St. Jude Children's Research Hospital. Patients: 1853 adult survivors of childhood cancer, aged 18 years or older, who received cancer-related cardiotoxic therapy at least 10 years earlier. Measurements: Baseline history and physical examination, fasting metabolic and lipid panels, echocardiography, electrocardiography, and 6-minute walk test. Results: One half of the survivors (52.3%) were men with a median age of 8 years (range, 0 to 24 years) at cancer diagnosis and 31 years (range, 18 to 60 years) at evaluation. Cardiomyopathy was present in 7.4% survivors (newly identified at the time of evaluation in 4.7%), coronary artery disease in 3.8% (newly identified in 2.2%), valvular regurgitation or stenosis in 28.0% (newly identified in 24.8%), and conduction or rhythm abnormalities in 4.4% (newly identified in 1.4%). Nearly all survivors were asymptomatic. The prevalence of cardiac conditions increased with age at evaluation, ranging from 3% to 24% among survivors aged 30 to 39 years to 10% to 37% among those aged 40 years or older. In multivariable analysis, survivors exposed to anthracycline doses of 250 mg/m2 or more had greater odds of cardiomyopathy (odds ratio, 2.7 [95% CI, 1.1 to 6.9]) than those who were not exposed. Survivors exposed to heart radiation also had increased odds of cardiomyopathy (odds ratio, 1.9 [CI, 1.1 to 3.7]) compared with those who were not exposed. Radiation exposure greater than 1500 cGy with any anthracycline exposure conferred the greatest odds for valve findings. Limitations: Sixty-one percent of survivors exposed to anthracycline chemotherapy or cardiac-directed radiation participated. A comparison group and longitudinal assessments were not available. Conclusion: Cardiovascular screening identified considerable subclinical disease among adult survivors of childhood cancer. Primary Funding Source: National Cancer Institute, American Lebanese Syrian Associated Charities.

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