Childhood cancer treatments linked to heart damage

Childhood cancer treatments linked to heart damage

4 Jan 2016

Childhood cancer survivors may face an increased risk of heart damage after exposure to certain chemotherapy and radiation treatments, a U.S. analysis suggests.

Previous research has linked cancer drugs known as anthracyclines to weakening of the heart muscle. Research has also tied some radiation therapy to cardiac rhythm disorders and structural damage in arteries and valves.

The current study not only reinforces these risks, it also suggests that many childhood cancer survivors may encounter serious cardiac issues at a relatively young age when doctors may not routinely screen patients for heart disease, said lead study author Dr. Daniel Mulrooney of St. Jude Children’s Research Hospital.

“A heart-healthy lifestyle, important for all patients, has increased importance for childhood cancer survivors who are at risk for cardiac disease at an earlier age than their peers,” Mulrooney commented.

Assessing data from nearly 2,000 adult survivors

To assess the prevalence of cardiac problems among former cancer patients, Mulrooney and colleagues examined data on 1,853 adult survivors of childhood tumors who received treatments associated with heart damage. About half of the survivors were men. Overall, half the patients had been less than eight years old when they were diagnosed. At the time of their cardiac evaluations, half were at least 31 years old.

More than 82% of participants had received anthracyclines during their cancer treatment, and more than 20% took higher cumulative doses of this chemotherapy that are linked to even greater odds of heart damage. Fewer than half of the survivors received radiation to the heart, but about 22% had a higher cardiac dose linked to an increased risk of complications down the line.

“Very few survivors had symptoms”

The prevalence of cardiac conditions increased with age at evaluation, ranging from:

• 3 to 24% among survivors aged 30 to 39
• to 10 to 37% among those 40 and older, the researchers reported.

Overall, the study revealed that:

• 7.4% of the survivors had cardiomyopathy, or chronic disease of the heart muscle
• 3.8% had coronary artery disease
• 28% had leaking or narrowing of heart valves
• 4.4% had heart rhythm abnormalities

In addition, very few survivors had symptoms, and many of them weren’t diagnosed with heart problems until they received evaluations as part of the study.

The limitations of the study

One limitation of the study is that it only included cancer survivors, making it impossible to compare the risk of heart damage to people who didn’t have cancer, the authors note. Newer treatment protocols established since these patients were treated more than a decade ago have also reduced exposure to chemotherapy and radiation that can damage the heart, Mulrooney said.

Some preliminary research has also suggested that a family of medicines known as beta-blockers might be given to childhood cancer patients to potentially minimize the future risk of heart damage, said Dr. Jean-Bernard Durand, medical director of the cardiomyopathy service at the University of Texas MD Anderson Cancer Center in Houston.

In case of high risk for heart disease, physicians should be vigilant

Except in rare instances, however, parents would not want to avoid treating cancer to minimize future heart risks, Durand noted. An exception might be made for kids whose heart function was so weak that receiving chemotherapy might overwhelm the heart.

Instead, patients who survive cancer should focus on making sure they have a complete record of the timing and dosage of any tumor treatments they received and alert doctors that they require cardiac screenings, Durand said. If they have other risks for heart disease, such as a family history, diabetes or high blood pressure, they need to be all the more vigilant, he added.

“Nearly all of the survivors in this study were asymptomatic in their 30s and 40s when they walked into the doctor’s office, and results show that they needed the physical normally given to patients in their 50s and 60s that includes a complete cardiac evaluation,” Durand added.

Source: Reuters