Screening for Anthracycline-Related Cardiac Dysfunction in Childhood Cancer Survivors: Can Less be More?

Armenian, Saro H.; Wong, F. Lennie

doi:10.1002/pbc.25693

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…Anthracycline chemotherapy and radiation therapy are two of the treatments that can increase risk for cardiovascular complications in children and AYA cancer survivors. The age at the time of treatment is important, as children younger than 5 years have a particularly increased risk for cardiotoxicity (13,31). Notably, patients younger than 25 years have been documented to present with abdominal symptoms, such as nausea and vomiting, as initial signs of exertion intolerance as opposed to typical cardiac symptoms, such as chest pain, shortness of breath, and palpitations (13).…”

Section: Cardiotoxicitymentioning

confidence: 99%

“…Notably, patients younger than 25 years have been documented to present with abdominal symptoms, such as nausea and vomiting, as initial signs of exertion intolerance as opposed to typical cardiac symptoms, such as chest pain, shortness of breath, and palpitations (13). Cumulative anthracycline and radiation therapy dosing must be documented before returning to sport, as toxicity occurs in a dose-dependent fashion and can result in cardiomyopathy, left ventricular dysfunction, heart failure, and arrhythmia (13,31,32). High-risk radiotherapy regions include the chest, abdomen, spine, and total body irradiation (13).…”

Section: Cardiotoxicitymentioning

confidence: 99%

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Clinical Considerations in Returning Pediatric and Young Adults With Cancer to Physical Activity

Dykowski,

Simoneau,

Smith

et al. 2023

Curr Sports Med Rep

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There is a gap in the literature on the best treatment of clinical sequelae within adolescent and young adult pediatric cancer populations. Children, adolescents, and young adults are at risk for a multitude of immediate and late effects of their disease and treatment that warrant a comprehensive, multidisciplinary team approach to optimize care. Sports medicine providers are well-equipped with their background to join the oncology rehabilitation team in diagnosing and managing cancer-related impairments to help these populations live a healthier and more active lifestyle. In this manuscript, four essential clinical components to consider when returning children, adolescents, and young adults with cancer history to physical activity are discussed: chemotherapy-induced peripheral neuropathy, cardiotoxicity, nutritional deficiencies, and deconditioning.

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Section: Cardiotoxicitymentioning

confidence: 99%

Section: Cardiotoxicitymentioning

confidence: 99%

Clinical Considerations in Returning Pediatric and Young Adults With Cancer to Physical Activity

Dykowski,

Simoneau,

Smith

et al. 2023

Curr Sports Med Rep

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“…In case of heart failure diagnosis and treatment should follow the established guidelines (23,24). Early detection of cardiac anomalies should be the goal allowing for preventive treatment in the asymptomatic setting (25). Clinical care guidelines have been established which recommend routine echocardiographic screening (26).…”

Section: Early Detection Of Cardiovascular Disease Dysfunction Vs Fmentioning

confidence: 99%

“…Effort was put into harmonizing this on an international level (25). Definition of risk groups in low (Anthracycline dose <100 mg/m 2 ), moderate (anthracycline dose 100 to <250 mg/m 2 or chest radiation ≥15 to <35 Gy) and high (anthracycline >250 mg/m 2 or chest radiation ≥35 Gy and combination of anthracycline ≥100 and radiation ≥15 Gy) was agreed on.…”

Section: Follow Up Throughout a Lifetime-monitoring Of Cardiac Functionmentioning

confidence: 99%

Cardio-toxicity in childhood cancer survivors “Cure is not enough”

2018

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Background According to the latest publication of data by the German Children's cancer registry (DKKR), the 5-year survival rate for children aged under 15 years is estimated with 85%. Since 1980, 47,650 patients have been documented (1). Attention is drawn towards cardiac or cardiovascular sequelae in childhood cancer survivors. Accordingly, this topic was covered in adult cancer survivor studies leading to the ESC position paper on cardiac toxicity, quoted in the subtitle mentioned above (2). There are publications on chemotherapy-induced cardiotoxicity (mainly anthracycline-associated) and additional risk factors. Also radiation, chronic disease, combination of chemotherapies and the introduction of new drugs need to be considered (3). Furthermore, asymptomatic (subclinical) or symptomatic cardiac events have to be distinguished (4). Asymptomatic ventricular dysfunction has been reported to be as high as 57% (5,6). The appearance of cardiomyopathy is reported from 2.8% to 29%, mostly in accordance to the dose of anthracyclines (7,8). Several population based registries or studies were reporting on late term problems of childhood cancer survivors and cardiovascular sequelae. The British Childhood Cancer Survivor Study (BCCSS) (9) represented a cohort of 34,489 5-year survivors of childhood cancer diagnosed between 1940 and 2006. They counted 181 cardiac deaths, a number 3.4 times higher than expected. In the group of participants of age 60 years and older, cardiac disease was present in 22% and vascular sequelae in 15% of the cases. Surprisingly, the mortality was highest among the patients diagnosed between 1980 and 1989. The Euro2K cohort followed 4,567 2-year survivors

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Utility of Echocardiography as Screening for Late-onset Anthracycline-induced Cardiotoxicity in Pediatric Cancer Survivors: Observations from the First Decade After End of Therapy

Moke

Schubert²,

Sun

et al. 2018

Journal of Pediatric Hematology/Oncology

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Current screening guidelines are available for anthracycline-induced cardiotoxicity. However, the utility of echocardiogram screening for late-onset anthracycline cardiotoxicity especially in the decade immediately after end of therapy is debatable. A retrospective chart review of patients seen in the Thriving after Cancer Clinic at Rady Children's Hospital January 2006 to December 2013 was performed. Treatment data, echocardiogram results, cardiology referral notes and cardiac medication data were abstracted from anthracycline-exposed survivors. Descriptive and univariate comparative statistics were performed. Of 368 patients (45% female, median 5.3 y old at diagnosis [range 0 to 18.3], median 5.0 y from end of therapy [EOT] [range 0 to 18.2]), a total of 4 patients (10-year cumulative incidence after EOT 1.3%; 95% confidence interval, 0.1%-19.7%) required cardiac medication for late-onset cardiotoxicity (>1 y after EOT). Those requiring medication for late-onset cardiotoxicity were exposed to more anthracyclines than survivors without cardiotoxicity (median, 360 mg/m [range, 300 to 375 mg/m] vs. 182 mg/m [range, 26 to 515 mg/m], P=0.009). None had neck or chest radiation. In this population, medication initiation for late-onset anthracycline cardiotoxicity was limited predominantly to the first 3 years after EOT, with the next >13 years after EOT. These findings add to the growing body of literature assessing current guidelines to inform improvements in screening practices of survivorship providers.

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Screening for Anthracycline-Related Cardiac Dysfunction in Childhood Cancer Survivors: Can Less be More?

Cited by 3 publications

References 20 publications

Clinical Considerations in Returning Pediatric and Young Adults With Cancer to Physical Activity

Clinical Considerations in Returning Pediatric and Young Adults With Cancer to Physical Activity

Cardio-toxicity in childhood cancer survivors “Cure is not enough”

Utility of Echocardiography as Screening for Late-onset Anthracycline-induced Cardiotoxicity in Pediatric Cancer Survivors: Observations from the First Decade After End of Therapy

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