Cardiovascular disease in survivors of childhood cancer

Insights into epidemiology, pathophysiology, and prevention

Saro H. Armenian, Gregory Armstrong, Gregory Aune, Eric J. Chow, Matthew J. Ehrhardt, Bonnie Ky, Javid Moslehi, Daniel A. Mulrooney, Paul C. Nathan, Thomas D. Ryan, Helena J. Van Der Pal, Elvira C. Van Dalen, Leontien C.M. Kremer

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Cardiovascular disease (CVD), which includes cardiomyopathy/heart failure, coronary artery disease, stroke, pericardial disease, arrhythmias, and valvular and vascular dysfunction, is a major concern for long-term survivors of childhood cancer. There is clear evidence of increased risk of CVD largely attributable to treatment exposures at a young age, most notably anthracycline chemotherapy and chest-directed radiation therapy, and compounded by traditional cardiovascular risk factors accrued during decades after treatment exposure. Preclinical studies are limited; thus, it is a high priority to understand the pathophysiology of CVD as a result of anticancer treatments, taking into consideration the growing and developing heart. Recently developed personalized risk prediction models can provide decision support before initiation of anticancer therapy or facilitate implementation of screening strategies in at-risk survivors of cancer. Although consensus-based screening guidelines exist for the application of blood and imaging biomarkers of CVD, the most appropriate timing and frequency of these measures in survivors of childhood cancer are not yet fully elucidated. Longitudinal studies are needed to characterize the prognostic importance of subclinical markers of cardiovascular injury on long-term CVD risk. A number of prevention trials across the survivorship spectrum are under way, which include primary prevention (before or during cancer treatment), secondary prevention (after completion of treatment), and integrated approaches to manage modifiable cardiovascular risk factors. Ongoing multidisciplinary collaborations between the oncology, cardiology, primary care, and other subspecialty communities are essential to reduce therapeutic exposures and improve surveillance, prevention, and treatment of CVD in this high-risk population.

Original languageEnglish (US)
Pages (from-to)2135-2144
Number of pages10
JournalJournal of Clinical Oncology
Volume36
Issue number21
DOIs
StatePublished - Jul 20 2018

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Survivors
Epidemiology
Cardiovascular Diseases
Neoplasms
Therapeutics
Anthracyclines
Primary Prevention
Secondary Prevention
Cardiology
Cardiomyopathies
Blood Vessels
Longitudinal Studies
Cardiac Arrhythmias
Coronary Artery Disease
Primary Health Care
Radiotherapy
Thorax
Survival Rate
Heart Failure
Biomarkers

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Cardiovascular disease in survivors of childhood cancer : Insights into epidemiology, pathophysiology, and prevention. / Armenian, Saro H.; Armstrong, Gregory; Aune, Gregory; Chow, Eric J.; Ehrhardt, Matthew J.; Ky, Bonnie; Moslehi, Javid; Mulrooney, Daniel A.; Nathan, Paul C.; Ryan, Thomas D.; Van Der Pal, Helena J.; Van Dalen, Elvira C.; Kremer, Leontien C.M.

In: Journal of Clinical Oncology, Vol. 36, No. 21, 20.07.2018, p. 2135-2144.

Research output: Contribution to journalReview article

Armenian, SH, Armstrong, G, Aune, G, Chow, EJ, Ehrhardt, MJ, Ky, B, Moslehi, J, Mulrooney, DA, Nathan, PC, Ryan, TD, Van Der Pal, HJ, Van Dalen, EC & Kremer, LCM 2018, 'Cardiovascular disease in survivors of childhood cancer: Insights into epidemiology, pathophysiology, and prevention', Journal of Clinical Oncology, vol. 36, no. 21, pp. 2135-2144. https://doi.org/10.1200/JCO.2017.76.3920
Armenian, Saro H. ; Armstrong, Gregory ; Aune, Gregory ; Chow, Eric J. ; Ehrhardt, Matthew J. ; Ky, Bonnie ; Moslehi, Javid ; Mulrooney, Daniel A. ; Nathan, Paul C. ; Ryan, Thomas D. ; Van Der Pal, Helena J. ; Van Dalen, Elvira C. ; Kremer, Leontien C.M. / Cardiovascular disease in survivors of childhood cancer : Insights into epidemiology, pathophysiology, and prevention. In: Journal of Clinical Oncology. 2018 ; Vol. 36, No. 21. pp. 2135-2144.
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