Long-Term Cardiovascular Outcomes in Childhood Cancer Survivors: A Systematic Review

TL;DR

Childhood cancer survivors face increased cardiovascular risks due to cancer treatments, with outcomes varying by cancer type, treatment, and demographics.

Contribution

This systematic review identifies specific cancer treatments and demographic factors linked to cardiovascular complications in childhood cancer survivors.

Findings

Anthracyclines, radiation therapy, and total body irradiation are associated with higher risks of cardiomyopathy and coronary artery disease.

Cardiometabolic challenges are more prevalent among non-Hispanic Black and Hispanic survivors.

Female survivors, especially those with higher anthracycline doses, face increased risks of peripartum cardiomyopathy.

Abstract

In recent years, childhood cancer appears to have become more common. Cardiovascular (CV) diseases have been cited as the leading cause of noncancer mortality among childhood cancer survivors. This systematic review evaluated the long-term CV outcomes of childhood cancer survivors. Eleven studies, published between 2015 and 2024 that satisfied the criteria for a thorough assessment, are included in the study. The research found consistent associations between specific cancer treatments, such as anthracyclines, radiation therapy, and total body irradiation, and increased risks of cardiomyopathy, coronary artery disease, and metabolic syndrome. Hematological malignancies, such as childhood acute lymphoblastic leukemia, and survivors of solid tumors like prostate and lung cancers were more specifically associated with CV complications. Although factors like obesity, hypertension, and insulin resistance were commonly reported, discrepancies based on race and gender were diverse across studies. Case in point, cardiometabolic challenges were more prevalent among non-Hispanic Black and Hispanic survivors, but these patterns were not uniform in all cohorts. Comparably, vulnerabilities such as peripartum cardiomyopathy were more evident in female survivors, particularly at younger ages and with higher anthracycline doses. These findings underscore both consistent and variable patterns of CV risks among childhood cancer survivors. The threats are influenced by the kind of cancer, the type of therapy, and demographic factors such as age, gender, and ethnicity. Thus, there is a need to put in place systematic, lifelong programs for cardiometabolic screening and risk reduction that are tailored to each person’s risk profile. These programs should include echocardiography, regular serum biomarker testing, lifestyle modifications (exercise, nutrition), and psychosocial support.

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