Individual prediction of heart failure among childhood cancer survivors

Eric J. Chow, Yan Chen, Leontien C. Kremer, Norman E. Breslow, Melissa M. Hudson, Gregory Armstrong, William L. Border, Elizabeth A.M. Feijen, Daniel M. Green, Lillian R. Meacham, Kathleen A. Meeske, Daniel A. Mulrooney, Kirsten K. Ness, Kevin C. Oeffinger, Charles A. Sklar, Marilyn Stovall, Helena J. Van Der Pal, Rita E. Weathers, Leslie L. Robison, And Yutaka Yasui

Research output: Contribution to journalArticle

75 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)394-402
Number of pages9
JournalJournal of Clinical Oncology
Volume33
Issue number5
DOIs
StatePublished - Feb 10 2015

Fingerprint

Survivors
Heart Failure
Neoplasms
Siblings
Wilms Tumor
Anthracyclines
Incidence
Heart Transplantation
Netherlands
Area Under Curve
Cohort Studies
Cardiovascular Diseases
Radiotherapy
Thorax
Demography
Therapeutics
Population

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Chow, E. J., Chen, Y., Kremer, L. C., Breslow, N. E., Hudson, M. M., Armstrong, G., ... Yasui, A. Y. (2015). Individual prediction of heart failure among childhood cancer survivors. Journal of Clinical Oncology, 33(5), 394-402. https://doi.org/10.1200/JCO.2014.56.1373

Individual prediction of heart failure among childhood cancer survivors. / Chow, Eric J.; Chen, Yan; Kremer, Leontien C.; Breslow, Norman E.; Hudson, Melissa M.; Armstrong, Gregory; Border, William L.; Feijen, Elizabeth A.M.; Green, Daniel M.; Meacham, Lillian R.; Meeske, Kathleen A.; Mulrooney, Daniel A.; Ness, Kirsten K.; Oeffinger, Kevin C.; Sklar, Charles A.; Stovall, Marilyn; Van Der Pal, Helena J.; Weathers, Rita E.; Robison, Leslie L.; Yasui, And Yutaka.

In: Journal of Clinical Oncology, Vol. 33, No. 5, 10.02.2015, p. 394-402.

Research output: Contribution to journalArticle

Chow, EJ, Chen, Y, Kremer, LC, Breslow, NE, Hudson, MM, Armstrong, G, Border, WL, Feijen, EAM, Green, DM, Meacham, LR, Meeske, KA, Mulrooney, DA, Ness, KK, Oeffinger, KC, Sklar, CA, Stovall, M, Van Der Pal, HJ, Weathers, RE, Robison, LL & Yasui, AY 2015, 'Individual prediction of heart failure among childhood cancer survivors', Journal of Clinical Oncology, vol. 33, no. 5, pp. 394-402. https://doi.org/10.1200/JCO.2014.56.1373
Chow, Eric J. ; Chen, Yan ; Kremer, Leontien C. ; Breslow, Norman E. ; Hudson, Melissa M. ; Armstrong, Gregory ; Border, William L. ; Feijen, Elizabeth A.M. ; Green, Daniel M. ; Meacham, Lillian R. ; Meeske, Kathleen A. ; Mulrooney, Daniel A. ; Ness, Kirsten K. ; Oeffinger, Kevin C. ; Sklar, Charles A. ; Stovall, Marilyn ; Van Der Pal, Helena J. ; Weathers, Rita E. ; Robison, Leslie L. ; Yasui, And Yutaka. / Individual prediction of heart failure among childhood cancer survivors. In: Journal of Clinical Oncology. 2015 ; Vol. 33, No. 5. pp. 394-402.
@article{f63ee2decd7a440ea3a5fa24c45f3fdb,
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.",
author = "Chow, {Eric J.} and Yan Chen and Kremer, {Leontien C.} and Breslow, {Norman E.} and Hudson, {Melissa M.} and Gregory Armstrong and Border, {William L.} and Feijen, {Elizabeth A.M.} and Green, {Daniel M.} and Meacham, {Lillian R.} and Meeske, {Kathleen A.} and Mulrooney, {Daniel A.} and Ness, {Kirsten K.} and Oeffinger, {Kevin C.} and Sklar, {Charles A.} and Marilyn Stovall and {Van Der Pal}, {Helena J.} and Weathers, {Rita E.} and Robison, {Leslie L.} and Yasui, {And Yutaka}",
year = "2015",
month = "2",
day = "10",
doi = "10.1200/JCO.2014.56.1373",
language = "English (US)",
volume = "33",
pages = "394--402",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "5",

}

TY - JOUR

T1 - Individual prediction of heart failure among childhood cancer survivors

AU - Chow, Eric J.

AU - Chen, Yan

AU - Kremer, Leontien C.

AU - Breslow, Norman E.

AU - Hudson, Melissa M.

AU - Armstrong, Gregory

AU - Border, William L.

AU - Feijen, Elizabeth A.M.

AU - Green, Daniel M.

AU - Meacham, Lillian R.

AU - Meeske, Kathleen A.

AU - Mulrooney, Daniel A.

AU - Ness, Kirsten K.

AU - Oeffinger, Kevin C.

AU - Sklar, Charles A.

AU - Stovall, Marilyn

AU - Van Der Pal, Helena J.

AU - Weathers, Rita E.

AU - Robison, Leslie L.

AU - Yasui, And Yutaka

PY - 2015/2/10

Y1 - 2015/2/10

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84922463517&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84922463517&partnerID=8YFLogxK

U2 - 10.1200/JCO.2014.56.1373

DO - 10.1200/JCO.2014.56.1373

M3 - Article

VL - 33

SP - 394

EP - 402

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 5

ER -