Cardiovascular Disease in Adult Survivors of Childhood Cancer

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...

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Bibliographic Details
Published in:Annual review of medicine 2015-01, Vol.66 (1), p.161-176
Main Authors: Lipshultz, Steven E, Franco, Vivian I, Miller, Tracie L, Colan, Steven D, Sallan, Stephen E
Format: Article
Language:English
Subjects:
ACE inhibitors
Adult
Antineoplastic Agents - adverse effects
Cancer
Cardiotonic Agents - therapeutic use
Cardiotoxicity - prevention & control
Cardiovascular disease
Cardiovascular Diseases - chemically induced
Cardiovascular Diseases - prevention & control
Child
Cytotoxicity
Dexrazoxane - therapeutic use
Doxorubicin - adverse effects
etiology
Humans
Neoplasms - drug therapy
prevention
Preventive medicine
screening
Survivor
Survivors
treatment
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Summary: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.
ISSN:0066-4219
1545-326X
DOI:10.1146/annurev-med-070213-054849