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 It's been known for years that some treatments for childhood cancer
increase the risk of heart failure. But in a new study of more than
43,000 children, Canadian researchers found young cancer survivors
had as much as a three-fold increased risk of developing a variety
of other cardiovascular problems, too, according to the report
published in Circulation.
The new findings suggest that survivors of childhood cancers should
focus on improving modifiable heart disease risk factors, such as
high blood pressure and diabetes, said study coauthor Dr. Paul
Nathan, a professor of pediatrics and health policy, management and
evaluation at the University of Toronto and a staff oncologist at
The Hospital for Sick Children.
There's a chance that there will be new cancer treatments that are
less toxic to the heart, Nathan said.
"However, we can't eliminate use of these (cardio-toxic) treatments
completely because they are needed to cure cancer," Nathan said in
an email. So, it's important to make "sure survivors and their
doctors are aware of the risks and (know) what to look out for."
The heightened risks also mean that childhood cancer survivors
should be screened for heart disease so it can be caught early,
Nathan said.
To take a closer look at the impact of childhood cancer therapies on
the heart, Nathan and his colleagues turned to a pediatric cancer
registry called the Pediatric Oncology Group of Ontario Networked
Information System, along with health data from the general public
collected by The Institute for Clinical Evaluative Sciences (ICES) a
nonprofit corporation.
The researchers focused on the 7,289 cancer survivors who had been
diagnosed before age 18, treated at a pediatric cancer center
between 1987 and 2010, and survived at least 5 years. Each of those
survivors was matched in age, gender and postal code to 5
cancer-free individuals from the general population, for a total of
36,205 individuals in the control group.
Half of the patients were tracked for more than 10 years. During
follow-up, 203 survivors (2.8%) experienced one or more cardiac
events as compared to 331 of those in the control group (0.9%).
When the researchers analyzed their data, they found that even at
relatively young ages, cancer survivors had a three-fold increased
risk for any type of heart event and as much as a ten-fold increased
risk for heart failure compared to their peers.
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Childhood cancer survivors also appeared to be at increased risk of
metabolic conditions such as diabetes, hypertension and high
cholesterol. And those conditions increased the risk of heart
disease.
Cancer survivors diagnosed with diabetes were more than three times
more likely to develop cardiovascular disease and more than 4 times
more likely to develop heart failure compared with nondiabetic
survivors. Similarly, those diagnosed with high blood pressure were
3 times more likely to develop heart failure compared to
non-hypertensive survivors.
This study is a useful reminder to not overlook traditional risk
factors and more common types of cardiovascular disease in childhood
cancer survivors, said Dr. Prashant Vaishnava, a cardiologist at The
Mount Sinai Hospital in New York City. "This is becoming a recurring
theme in medicine as patients are able to survive diseases that once
may have been quickly fatal. The treatment paradigm for these
survivors shifts to management of those conditions which are
ubiquitous in the general population."
These days many pediatric cancer centers follow survivors of
childhood cancers for possible heart damage, said Dr. Kirsten Rose-Felker,
a pediatric cardiologist at UPMC Children's Hospital of Pittsburgh.
While many will just need to be monitored for the rest of their
lives, some children suffer severe damage to their hearts from the
cancer treatments, Rose-Felker said. "We've taken care of patients
who needed a heart transplant," she added. "The damage can be so bad
that it completely destroys the heart muscle."
The number of children who will need to be watched for heart
problems is on the rise, Rose-Felker said. "There are half a million
childhood cancer survivors in the U.S. and that number continues to
grow as treatments get better," she added.
The good news, Rose-Felker said, is that this is "something we can
actually affect."
SOURCE: http://bit.ly/344iA04 Circulation, online August 26, 2019.
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