Cardiac Disease in Childhood Cancer Survivors : Risk Prediction, Prevention, and Surveillance: JACC CardioOncology State-of-the-Art Review

Abstract

Cardiac diseases in the growing population of childhood cancer survivors are of major concern. Cardiotoxicity as a consequence of anthracyclines and chest radiotherapy continues to be relevant in the modern treatment era. Mitoxantrone has emerged as an important treatment-related risk factor and evidence on traditional cardiovascular risk factors in childhood cancer survivors is accumulating. International surveillance guidelines have been developed with the aim to detect and manage cardiac diseases early and prevent symptomatic disease. There is growing interest in risk prediction models to individualize prevention and surveillance. This State-of-the-Art Review summarizes literature from a systematic PubMed search focused on cardiac diseases after treatment for childhood cancer. Here, we discuss the prevalence, risk factors, prevention, risk prediction, and surveillance of cardiac diseases in survivors of childhood cancer.

Central Illustration

Highlights

• •

  The main risk factors for cardiac disease in childhood cancer survivors are anthracyclines, mitoxantrone, and chest-directed radiotherapy dose.

• •

  Primary prevention strategies may reduce the risk of anthracycline-induced cardiomyopathy.

• •

  There is an increased prevalence of traditional cardiovascular risk factors in childhood cancer survivors; screening and early management are important to modify risk.

• •

  Multivariable risk prediction models may help to individualize prevention and surveillance strategies.