Journal of Clinical Oncology, 2008 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 26, No 15S (May 20 Supplement), 2008: 9509
© 2008 American Society of Clinical Oncology

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Abstract

Cardiovascular disease in adult survivors of childhood and adolescent cancer: A report from the Childhood Cancer Survivor Study (CCSS)

University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Roswell Park Cancer Institute, Buffalo, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; St. Jude Children’s Research Hospital, Memphis, TN; Emory University, Atlanta, GA

9509

Background: Previous research has shown that cardiovascular disease contributes to significant morbidity and mortality among survivors of childhood and adolescent cancer. Few studies have reported risk factors in long-term survivors who are now adults. Methods: This analysis includes 14,358 five-yr cancer survivors of the CCSS diagnosed age 21, between 1970–1986, with one of eight childhood cancers [leukemia, CNS tumors, Hodgkin’s or non-Hodgkin’s lymphomas, renal tumors, neuroblastoma, soft- tissue sarcomas, or bone cancers]. Self-reported cardiac outcomes occurring at least 5-yrs post-dx are compared to a sibling control group (N=3899) and across treatment groups using Cox proportional hazards models to estimate relative risks (RR) adjusted for age, gender, race, sociodemographic factors, and smoking status. Results: Survivors (54% males) were on average 7.8 yrs (0–20) at diagnosis, and 27.5 yrs (8–51) at follow-up. Compared to siblings, survivors were more likely to report congestive heart failure (CHF) (RR 5.7 95% CI 3.4–9.6), myocardial infarction (MI) (RR 4.9 95% CI 2.3–10.4), atherosclerosis (RR 10.2 95% CI 3.7–28.3), pericardial (RR 6.3 95% CI 3.3–11.9) and valvular disease (RR 4.8 95% CI 3.0–7.6), and coronary angiography (RR 8.2 95% CI 4.2–16.1). Anthracycline exposure 250 mg/m2 increased the risk of reported CHF (RR 4.1 95% CI 3.0–5.6), pericardial (RR 1.9 95% CI 1.3–2.9) and valvular disease (RR 1.8 95% CI 1.3–2.5), and angiography (RR 2.6 95% CI 1.8–3.7) compared to unexposed survivors. Radiation (RT) to the heart also increased the risk of CHF (RR 2.0 95% CI 1.4–2.8), MI (RR 1.9 95% CI 1.1–3.2), atherosclerosis (RR 5.3 95% CI 2.5–11.0), pericardial (RR 2.2 95% CI 1.4–3.3) and valvular disease (RR 2.8 95% CI 1.9–4.0), and angiography (RR 2.2 95% CI 1.5–3.2) compared to those survivors without cardiac directed RT. Conclusion: The occurrence of premature cardiovascular diseases is substantial in this young adult population of cancer survivors.

No significant financial relationships to disclose.

Abstract presentation from the 2008 ASCO Annual Meeting