Monitoring for Cardiovascular Disease in Survivors of Childhood Cancer: Report From the Cardiovascular Disease Task Force of the Children's Oncology Group

Abstract

Curative therapy for childhood cancer has improved significantly in the last 2 decades such that, at present, approximately 80% of all children with cancer are likely to survive > or = 5 years after diagnosis. Prevention, early diagnosis, and treatment of long-term sequelae of therapy have become increasingly more significant as survival rates continue to improve. Cardiovascular disease is a well-recognized cause of increased late morbidity and mortality among survivors of childhood cancer. The Children's Oncology Group Late Effects Committee and Nursing Discipline and Patient Advocacy Committee have recently developed guidelines for follow-up of long-term survivors of pediatric cancer. A multidisciplinary task force critically reviewed the existing literature to evaluate the evidence for the cardiovascular screening recommended by the Children's Oncology Group guidelines. In this review we outline the clinical manifestations of late cardiovascular toxicities, suggest modalities and frequency of monitoring, and address some of the controversial and unresolved issues regarding cardiovascular disease in childhood cancer survivors.

Monitoring risk factors of cardiovascular disease in cancer survivors

“…[16][17][18][19][20] For example, the recent joint guidelines from the Center for International Blood and Marrow Transplant Research and European Society for Blood and Marrow Transplantation 16 recommend specific frequency of monitoring and treatment targets for individual CVD risk factors in cancer survivors following haematopoietic cell transplantation (HCT). These guidelines recommend screening at every clinic visit (at least once a year) for weight, body mass index (BMI) and BP, and yearly for waist circumference.…”

“…A report from the Cardiovascular Disease Task Force of the Children's Oncology Group suggests monitoring fasting glucose and lipid profile every 3-5 years for survivors of childhood cancer. 18 Other guidelines on CVD risk monitoring of survivors of childhood malignancy recommend that, in additional to fasting glucose, lipids and HbA1C (although no specific frequency suggested), referral to endocrinologists should be considered for those with increased risk, eg bone marrow transplant recipients, especially total body irradiation or busulphan-based conditioning. 21 While the precise monitoring frequency remains debatable and challenging, it is clear that monitoring, on the one hand should be tailored to the individual based on risk level (eg bone marrow transplant recipients, cranial radiotherapy, glucocorticoid treatment, growth hormone deficiency or high BMI/large waist circumference), and on the other hand should be recommended for all cancer survivors since =112 (p<0.001).…”

“…9,10 In parallel to CVD, metabolic disturbances -including obesity and central fat distribution indicated by large waist circumference, hypertension, dyslipidaemia and diabetes -which may be aggravated by cancer therapies, all also develop progressively post-treatment. [11][12][13][14][15] There are guidelines on monitoring CVD risk factors with the most recent recommendations for survivors of haematological cancer being the most comprehensive; 16 previous recommendations have tended to be vague [17][18][19] or show little information on CVD risk monitoring. 20,21 Because of the complexity of late effects of cancer treatment, awareness of CVD risks among cancer survivors is low; little is known about the quality of risk monitoring and CVD-directed health promotion in cancer survivors in clinical practice.…”

Cardiovascular disease after hematopoietic cell transplantation - lessons learned

“…39,41 Parameters of systolic and diastolic function can easily be measured with sufficient accuracy, and thus echocardiography offers clinicians a non-invasive, cost-effective, and widely available option for serial evaluation in patients at risk of this complication. 42 However, measures such as left ventricular ejection fraction (LVEF) and certain diastolic parameters are highly load-dependent, sensitive to changes in the circulatory system and rather non-specific.…”

“…39,40 Documentation of exposure to cardiotoxic agents such as anthracyclines and radiation, as well as the presence of co-morbidities such as hypertension, dyslipidemia, and renal insufficiency should determine the nature and frequency of monitoring.…”