TY - JOUR
T1 - Increased risk of cardiac ischaemia in a pan-European cohort of 36 205 childhood cancer survivors: A PanCareSurFup study
AU - Feijen, Elizabeth Arnoldina Maria
AU - van Dalen, Elvira C.
AU - van der Pal, Heleen J. H.
AU - Reulen, Raoul C.
AU - Winter, David L.
AU - Keuhni, Claudia E.
AU - Morsellino, Vera
AU - Alessi, Daniela
AU - Allodji, Rodrigue S.
AU - Byrne, Julliana
AU - Bardi, Edit
AU - Jakab, Zsuzsanna
AU - Grabow, Desiree
AU - Garwicz, Stanislaw
AU - Haddy, Nadia
AU - Jankovic, Momcilo
AU - Kaatsch, Peter
AU - Levitt, Gill A.
AU - Ronckers, Cecile M.
AU - Schindera, Christina
AU - Skinner, Roderick
AU - Zalatel, Lorna
AU - Hjorth, Lars
AU - Tissing, Wim J. E.
AU - de Vathaire, Florent
AU - Hawkins, Mike M.
AU - Kremer, Leontien C. M.
N1 - Funding Information: Funding Supported by the European Union’s Seventh Framework Programme for research, technological development and demonstration (Grant Agreement No. 257505; PanCareSurFup). CMR was supported by grant funding from the Dutch Cancer Society. The Swiss Childhood Cancer Registry and the Swiss Childhood Cancer Survivor Study are supported by the Swiss Paediatric Oncology Group, the Swiss Cancer League (KLS-3412-02-2014, KLS-3886-02-2016), Swiss Cancer Research (KFS-02783-02-2011), the Swiss National Science Foundation (PDFMP3_141775), Kinderkrebshilfe Schweiz, the Federal Office of Public Health and the National Institute of Cancer Epidemiology and Registration. Slovenian Research Agency. The French Childhood Cancer Survivor Cohort is supported by the French Society of Childhood Cancer (SFCE), ARC foundation with the Pop-HaRC and CHART projects, the French National Cancer Institute (INCA) with Programme Hospitalier de Recherche Clinique, the Pfizer Foundation for childhood and adolescent health, the Ligue Nationale Contre le Cancer (LNCC), the Institut de Recherche en Santé Publique (IRESP) and the French ’Agence Nationale Pour la Recherche Scientifique’ (Hope-Epi Project). Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Objective In this report, we determine the cumulative incidence of symptomatic cardiac ischaemia and its risk factors among European 5-year childhood cancer survivors (CCS) participating in the PanCareSurFup study. Methods Eight data providers (France, Hungary, Italy (two cohorts), the Netherlands, Slovenia, Switzerland and the UK) participating in PanCareSurFup ascertained and validated symptomatic cardiac events among their 36 205 eligible CCS. Data on symptomatic cardiac ischaemia were graded according to the Criteria for Adverse Events V.3.0 (grade 3-5). We calculated cumulative incidences, both overall and for different subgroups based on treatment and malignancy, and used multivariable Cox regression to analyse risk factors. Results Overall, 302 out of the 36 205 CCS developed symptomatic cardiac ischaemia during follow-up (median follow-up time after primary cancer diagnosis: 23.0 years). The cumulative incidence by age 60 was 5.4% (95% CI 4.6% to 6.2%). Men (7.1% (95% CI 5.8 to 8.4)) had higher rates than women (3.4% (95% CI 2.4 to 4.4)) (p<0.0001). Of importance is that a significant number of patients (41/302) were affected as teens or young adults (14-30 years). Treatment with radiotherapy/chemotherapy conferred twofold risk (95% CI 1.5 to 3.0) and cases in these patients appeared earlier than in CCS without treatment/surgery only (15% vs 3% prior to age 30 years, respectively (p=0.04)). Conclusions In this very large European childhood cancer cohort, we found that by age 60 years, 1 in 18 CCS will develop a severe, life-threatening or fatal cardiac ischaemia, especially in lymphoma survivors and CCS treated with radiotherapy and chemotherapy increases the risk significantly.
AB - Objective In this report, we determine the cumulative incidence of symptomatic cardiac ischaemia and its risk factors among European 5-year childhood cancer survivors (CCS) participating in the PanCareSurFup study. Methods Eight data providers (France, Hungary, Italy (two cohorts), the Netherlands, Slovenia, Switzerland and the UK) participating in PanCareSurFup ascertained and validated symptomatic cardiac events among their 36 205 eligible CCS. Data on symptomatic cardiac ischaemia were graded according to the Criteria for Adverse Events V.3.0 (grade 3-5). We calculated cumulative incidences, both overall and for different subgroups based on treatment and malignancy, and used multivariable Cox regression to analyse risk factors. Results Overall, 302 out of the 36 205 CCS developed symptomatic cardiac ischaemia during follow-up (median follow-up time after primary cancer diagnosis: 23.0 years). The cumulative incidence by age 60 was 5.4% (95% CI 4.6% to 6.2%). Men (7.1% (95% CI 5.8 to 8.4)) had higher rates than women (3.4% (95% CI 2.4 to 4.4)) (p<0.0001). Of importance is that a significant number of patients (41/302) were affected as teens or young adults (14-30 years). Treatment with radiotherapy/chemotherapy conferred twofold risk (95% CI 1.5 to 3.0) and cases in these patients appeared earlier than in CCS without treatment/surgery only (15% vs 3% prior to age 30 years, respectively (p=0.04)). Conclusions In this very large European childhood cancer cohort, we found that by age 60 years, 1 in 18 CCS will develop a severe, life-threatening or fatal cardiac ischaemia, especially in lymphoma survivors and CCS treated with radiotherapy and chemotherapy increases the risk significantly.
KW - myocardial disease
UR - http://www.scopus.com/inward/record.url?scp=85090119960&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/heartjnl-2020-316655
DO - https://doi.org/10.1136/heartjnl-2020-316655
M3 - Article
C2 - 32826285
SN - 1355-6037
VL - 107
SP - 33
EP - 40
JO - Heart
JF - Heart
IS - 1
M1 - heartjnl-2020-316655
ER -