Cardiovascular disease in adult survivors of childhood cancer

Steven E. Lipshultz, Vivian I. Franco, Tracie L. Miller, Steven D. Colan, Stephen E. Sallan

Research output: Contribution to journalArticle

56 Scopus citations

Abstract

Treatment advances have increased survival in children with cancer, but subclinical, progressive, irreversible, and sometimes fatal treatment-related cardiovascular effects may appear years later. Cardio-oncologists have identified promising preventive and treatment strategies. Dexrazoxane provides long-term cardioprotection from doxorubicin-associated cardiotoxicity without compromising the efficacy of anticancer treatment. Continuous infusion of doxorubicin is as effective as bolus administration in leukemia treatment, but no evidence has indicated that it provides long-term cardioprotection; continuous infusions should be eliminated from pediatric cancer treatment. Angiotensin-converting enzyme inhibitors can delay the progression of subclinical and clinical cardiotoxicity. All survivors, regardless of whether they were treated with anthracyclines or radiation, should be monitored for systemic inflammation and the risk of premature cardiovascular disease. Echocardiographic screening must be supplemented with screening for biomarkers of cardiotoxicity and perhaps by identification of genetic susceptibilities to cardiovascular diseases; optimal strategies need to be identified. The health burden related to cancer treatment will increase as this population expands and ages.

Original languageEnglish (US)
Pages (from-to)161-176
Number of pages16
JournalAnnual review of medicine
Volume66
DOIs
StatePublished - Jan 14 2015

Keywords

  • etiology
  • prevention
  • screening
  • treatment

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)

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  • Cite this

    Lipshultz, S. E., Franco, V. I., Miller, T. L., Colan, S. D., & Sallan, S. E. (2015). Cardiovascular disease in adult survivors of childhood cancer. Annual review of medicine, 66, 161-176. https://doi.org/10.1146/annurev-med-070213-054849