Late cardiotoxicity in aging adult survivors of childhood cancer

Gregory Armstrong, Jordan D. Ross

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

The survival rate for childhood cancer is steadily improving, and the current estimate for the prevalence of childhood cancer survivors in the United States is 420,000. With this encouraging trend and the aging of this population, there is an ever-increasing responsibility to identify adult survivors of childhood cancer with adverse health outcomes related to cancer treatment across the span of their lives. To accomplish this, large cohort studies have been developed to follow survivors longitudinally. Compared to siblings, survivors have a higher cumulative incidence of morbidity and mortality, and this gap in incidence only widens with age. One of the most significant late toxicities in survivors is late onset cardiotoxicity, largely due to anthracycline and chest-directed radiation exposure. Survivors also have an increased prevalence of traditional cardiovascular risk factors as they age, which potentiates the risk for major cardiac events. Prevention is essential. Minimizing anthracycline dose exposure in pediatric cancer patients is a primary method of cardioprotection. Dexrazoxane and enalapril have also been studied as primary (pre-exposure) and secondary (post-exposure) cardioprotectant agents, respectively. Additionally, the Children's Oncology Group has published exposure-driven, risk-based screening guidelines for long-term follow-up, which may be a cost-effective way to identify subclinical cardiac disease before progression to clinical presentation. Ongoing research is needed to determine the most effective diagnostic modality for screening (e.g. echocardiography), and the most effective intervention strategies to improve long-term outcomes.

Original languageEnglish (US)
Pages (from-to)19-26
Number of pages8
JournalProgress in Pediatric Cardiology
Volume36
Issue number1-2
DOIs
StatePublished - Jan 1 2014

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Survivors
Neoplasms
Anthracyclines
Dexrazoxane
Enalapril
Second Primary Neoplasms
Incidence
Echocardiography
Disease Progression
Cardiotoxicity
Siblings
Heart Diseases
Cohort Studies
Thorax
Survival Rate
Guidelines
Pediatrics
Morbidity
Costs and Cost Analysis
Mortality

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Late cardiotoxicity in aging adult survivors of childhood cancer. / Armstrong, Gregory; Ross, Jordan D.

In: Progress in Pediatric Cardiology, Vol. 36, No. 1-2, 01.01.2014, p. 19-26.

Research output: Contribution to journalReview article

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