NYMC Faculty Publications

Cardio-Oncology Issues Among Pediatric Cancer and Stem Cell Transplant Survivors

Author Type(s)

Faculty

DOI

10.1097/CRD.0000000000000030

Journal Title

Cardiology in Review

First Page

268

Last Page

274

Document Type

Article

Publication Date

1-1-2014

Department

Pediatrics

Keywords

Adolescent, Adult, Antineoplastic Agents, Biomarkers, Cardiotonic Agents, Child, Echocardiography, Heart Diseases, Humans, Magnetic Resonance Angiography, Neoplasms, Radiotherapy, Risk Factors, Stem Cell Transplantation, Survivors

Disciplines

Medicine and Health Sciences

Abstract

Improvements in the survival of children and adolescents diagnosed with cancer have resulted in a growing population of childhood, adolescent and adult cancer and stem cell transplant survivors. Approximately two thirds of these survivors will experience at least 1 late effect of their treatment, and about one third will experience a late effect that is severe or life threatening. Childhood cancer survivors are at high risk for development of severe cardiac disease, particularly after anthracycline and/or radiation exposure. Cardiotoxicity can present as early cardiac dysfunction during or shortly after therapy or as chronic impairment of cardiac function several years after treatment. Attempts to minimize serious adverse effects have included reduction of high-dose chemotherapy, particularly anthracycline dosing to < 350 mg/m, use of cardioprotective agents such as dexrazoxane and decreased radiation dosing and radiation fields. There have been no convincing data showing medical interventions that can reliably slow or reverse cardiotoxicity in treated patients, which therefore warrants further studies looking at the use of beta blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or newer agents either prior to or following the discovery of heart damage. Emphasis on the prevention of further damage is critical and can be accomplished through aggressive surveillance, including screening for lipid abnormalities, cardiac biomarkers such as troponins and B-type natriuretic peptides, hypertension, diabetes and obesity as well as the use of echocardiography and cardiac magnetic resonance imaging to identify abnormalities early in their course. Here, we provide an overview of the field of cardio-oncology to stimulate interest among cardiologists.

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