Author + information
- Jan M. Leerink, MDa,∗,
- Esmée C. de Baat, MDb,∗,
- Elizabeth A.M. Feijen, PhDb,
- Louise Bellersen, MDc,
- Elvira C. van Dalen, MD, PhDb,
- Heynric B. Grotenhuis, MD, PhDd,
- Livia Kapusta, MD, PhDe,f,
- Wouter E.M. Kok, MD, PhDa,
- Jacqueline Loonen, MD, PhDg,
- Heleen J.H. van der Pal, MD, PhDb,
- Saskia M.F. Pluijm, PhDb,
- Arco J. Teske, MD, PhDh,
- Annelies M.C. Mavinkurve-Groothuis, MD, PhDb,
- Remy Merkx, MDi,† and
- Leontien C.M. Kremer, MD, PhDb,∗,† (, )@prinsesmaximac
- aDepartment of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- bDepartment of Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
- cDepartment of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
- dDepartment of Pediatric Cardiology, Wilhelmina Children's Hospital, University of Utrecht, Utrecht, the Netherlands
- eDepartment of Pediatric Cardiology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
- fDepartment of Pediatrics, Tel Aviv University, Sackler School of Medicine, Tel Aviv Sourasky Medical Center, Pediatric Cardiology Unit, Tel Aviv, Israel
- gDepartment of Pediatric Hematology and Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
- hDepartment of Cardiology, Utrecht University Medical Center, Utrecht, the Netherlands
- iDepartment of Medical Imaging, Radboud University Medical Center, Medical UltraSound Imaging Center, Nijmegen, the Netherlands
- ↵∗Address for correspondence:
Dr. Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands.
• 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.
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.
↵∗ Drs. Leerink and de Baat are co-first authors.
↵† Drs. Merkx and Kremer are co-last authors. This paper was supported by a Dutch Heart Foundation Grant (CVON2015-21).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: CardioOncology author instructions page.
- Received July 1, 2020.
- Revision received August 7, 2020.
- Accepted August 8, 2020.
- 2020 The Authors