Late Cardiac Effects in Childhood Cancer Survivors

Within the first 30 years after cancer diagnosis, survivors of childhood cancers have an estimated 75% cumulative incidence of treatment-related chronic health problems. In the United States, where 1 in 680 people between 20 and 50 years old are survivors of childhood cancer, the impact of long-term health consequences is concerning, particularly because this population is growing. Cancer treatment-related cardiotoxicity is the leading noncancer cause of morbidity, and after 30 years, exceeds the mortality rates of cancer recurrence. Cumulative anthracycline chemotherapy dose received is one of the major risk factors. Others include female sex, younger age at diagnosis, and now emerging genetic mutations. However, evidence-based guidelines to identify and monitor cardiotoxicity are lacking. Dexrazoxane provides cardioprotective benefits in children with high-risk cancers, but additional preventive strategies are still needed. An improved understanding of the lifetime cardiovascular risk associated with these factors in long-term childhood cancer survivors may help guide treatment and predict any potential additional cardiovascular risk of specific cancer therapies, such as anthracyclines.