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- Hammoud, Rawan A., et al.
(författare)
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The burden of cardiovascular disease and risk for subsequent major adverse cardiovascular events in survivors of childhood cancer: a prospective, longitudinal analysis from the St Jude Lifetime Cohort Study
- 2024
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Ingår i: LANCET ONCOLOGY. - 1470-2045 .- 1474-5488. ; 25:6, s. 811-822
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Tidskriftsartikel (refereegranskat)abstract
- Background The effect of the increasing lifetime burden of non -major cardiovascular conditions on risk for a subsequent major adverse cardiovascular event among survivors of childhood cancer has not been assessed. We aimed to characterise the prevalence of major adverse cardiovascular events and their association with the cumulative burden of non -major adverse cardiovascular events in childhood cancer survivors. Methods This is a longitudinal cohort study with participant data obtained from an ongoing cohort study at St Jude Children's Research Hospital: the St Jude Lifetime Cohort Study (SJLIFE). Prospective clinical follow-up was of 5 -year survivors of childhood cancer who were diagnosed when aged younger than 25 years from 1962 to 2012. Agefrequency, sex -frequency, and race -frequency matched community -control participants completed a similar one-time clinical assessment. 22 cardiovascular events were graded using a St Jude Children's Research Hospital -modified version of the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03). Cumulative incidence and burden of the primary outcome of major adverse cardiovascular events (cardiomyopathy, myocardial infarction, stroke, and other cardiovascular -related mortality) were estimated. Rate ratios (RR) of the association of major adverse cardiovascular events with 22 non -major adverse cardiovascular events were estimated using multivariable piecewise-exponential regression adjusting for attained age, age at diagnosis, sex, race and ethnicity, treatment era, diagnosis of diabetes, and exposure to cardiotoxic cancer therapies. The St Jude Lifetime Cohort study is registered with ClinicalTrials.gov, NCT00760656, and is ongoing. Findings 9602 5 -year survivors of childhood cancer, and 737 community controls were included in the longitudinal follow-up (from Sept 13, 2007, to Dec 17, 2021). The median follow-up was 203 years (IQR 120-314) from the date of primary cancer diagnosis (4311 [44.9%] were females). By the age of 50 years (analysis stopped at age 50 years due to the low number of participants older than that age), the cumulative incidence of major adverse cardiovascular events among survivors was 177% (95% CI 159-195) compared with 09% (00-21) in the community controls. The cumulative burden of major adverse cardiovascular events in survivors was 026 (95% CI 023-029) events per survivor compared with 0009 (0000-0021) events per community control participant. Increasing cumulative burden of grade 1-4 non -major adverse cardiovascular events was associated with an increased future risk of major adverse cardiovascular events (one condition: RR 43, 95% CI 31-60; p<00001; two conditions: 66, 46-95; p<00001; and three conditions: 77, 51-114; p<00001). Increased risk for major adverse cardiovascular events was observed with specific subclinical conditions (eg, grade 1 arrhythmias [RR 15, 95% CI 12-20; p=00017]), grade 2 left ventricular systolic dysfunction (22, 16-31; p<00001), grade 2 valvular disorders (22, 12-40; p=0013), but not grade 1 hypercholesterolaemia, grade 1-2 hypertriglyceridaemia, or grade 1-2 vascular stenosis. Interpretation Among an ageing cohort of survivors of childhood cancer, the accumulation of non -major adverse cardiovascular events, including subclinical conditions, increased the risk of major adverse cardiovascular events and should be the focus of interventions for early detection and prevention of major adverse cardiovascular events. Funding The US National Cancer Institute and the American Lebanese Syrian Associated Charities. Copyright (c) 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.
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| 2. |
- Landier, Wendy, et al.
(författare)
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Surveillance for late effects in childhood cancer survivors
- 2018
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Ingår i: Journal of Clinical Oncology. - 0732-183X. ; 36:21, s. 2216-2222
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Forskningsöversikt (refereegranskat)abstract
- Many childhood cancer survivors carry a significant risk for late morbidity and mortality, a consequence of the numerous therapeutic exposures that contribute to their cure. Focused surveillance for late therapy-related complications provides opportunities for early detection and implementation of health-preserving interventions. The substantial body of research that links therapeutic exposures used during treatment of childhood cancer to adverse outcomes among survivors enables the characterization of groups at the highest risk for developing complications related to specific therapies; however, methods available to optimize screening strategies to detect these therapy-related complications are limited. Moreover, the feasibility of conducting clinical trials to test screening recommendations for childhood cancer survivors is limited by requirements for large sample sizes, lengthy study periods, prohibitive costs, and ethical concerns. In addition, the harms of screening should be considered, including overdiagnosis and psychological distress. Experts in several countries have developed guideline recommendations for late effects surveillance and have collaborated to harmonize these recommendations internationally to enhance long-term follow-up care and quality of life for childhood cancer survivors. Methods used in these international efforts include systematic literature searches, development of evidence-based summaries, rigorous evaluation of the evidence, and formulation of consensus-based surveillance recommendations for each late complication. Alternate methods to refine recommendations, such as cumulative burden assessment and risk prediction and cost-effectiveness modeling, may provide novel approaches to guide survivorship care in this vulnerable population and, thus, represents a worthy objective for future international survivorship collaborations.
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