Kesting S, Giordano U, Weil J, McMahon CJ, Albert DC, Berger C, Budts W, Fritsch P, Hidvégi EV, Oberhoffer-Fritz R, Milano GM, Wacker-Gußmann A, Herceg-Čavrak V. Cardiol Young. 2024 Feb;34(2):250-261. doi: 10.1017/S1047951123004213. Epub 2024 Jan 4. PMID: 38174736 Review.
Take home points:
- Regular cardiac screening is necessary in long-term pediatric cancer survivors
- Modifiable lifestyle factors should be addressed
- Exercise assessment and exercise training are underappreciated and likely very helpful for these patients
Commentary from Dr. Jared Hershenson (Greater Washington DC), section editor of Pediatric Cardiology Journal Watch:
With the improved survival of pediatric cancer patients, the long-term health effects are becoming increasingly important. Besides secondary malignancies, many known adverse cardiac issues can develop due to cardiotoxicity from chemotherapy and radiation therapy to the chest, such as cardiomyopathies, valve dysfunction, arrhythmias, peripheral vascular disease, pericardial disease, and early coronary artery disease. See Table 1. This article is a consensus guidelines statement from the European Paediatric and Congenital Cardiology Working group.
Summary as follows:
Primary prevention includes dexrazoxane, liposomal anthracyclines, and a longer duration of infusions. Secondary prevention was discussed in much more detail. Those with high and moderate risk should have lifelong surveillance, usually recommended every few years; see Table 4. Given that many patients may have subclinical dysfunction, standard testing may not detect changes. Global longitudinal strain should be added to echocardiography and MRI considered if there is insufficient information on myocardial performance. Additionally, provocative testing such as cardiopulmonary exercise testing (CPET) +/- stress imaging may be helpful in the detection of early myocardial changes. Hypertension and metabolic syndrome are also common.
Decreased physical fitness is possibly a modifiable risk factor in long-term survivors. Many survivors likely have decreased peak VO2 and if they have subclinical cardiomyopathies, may not be able to increase cardiac output appropriately. Exercise therapy may be a critical component of long-term health and reductions in morbidity and mortality, but research is in its early stages. While physical activity recommendations are provided for the general population, those with a history of chronic illness and a higher risk of CVD may have greater benefits.