Study details heart problems after childhood cancer
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Survivors of childhood cancer who had aggressive chemotherapy are at increased risk of structural and functional heart problems, a new study indicates.
Both chemotherapy, especially with drugs called anthracyclines, and radiation to the chest are known to increase the risk of heart damage among childhood cancer survivors, Dr. Veronika Velensek of the University Children’s Hospital Ljubljana in Slovenia and colleagues note.
To better understand the risk factors for cardiovascular disease among these patients, Velensek and her team performed a battery of tests of heart structure and function in 211 patients who had survived for at least five years after being diagnosed with cancer in childhood. All were treated between 1968 and 1998.
More than half (53 percent) had signs of heart damage.
Individuals treated most recently (1989-1998) were at greatest risk, the researchers found; nearly three-quarters of these patients had heart damage. These patients were all treated with intensive chemotherapy with several drugs, including high doses of anthracyclines, the researchers note.
Patients who underwent radiation were at increased risk of heart valve disease. Those treated for Hodgkin’s disease between 1968 and 1988 were at greatest risk. “A possible explanation for this could be that in the time period higher doses of irradiation were used…older radiation therapy techniques were available and less effective shielding was used,” the researchers write in the online medical journal BMC Cancer.
Patients who had received a large total dose of anthracyclines and were treated with drugs called alkylating agents at the same time were most likely to have systolic dysfunction, or problems with contraction of the heart’s main pumping chambers, as well as enlargement of the chambers on the left side of the heart.
The researchers also found that 46 percent of the patients had below-normal exercise tolerance. While no specific type of treatment was linked to poor fitness, the researchers note, the fact that one third of the patients were sedentary and obese may have been a factor.
SOURCE: BMC Cancer, May 20, 2008.
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