Cardiovascular mortality among 76 864 survivors of childhood cancers in the United States: a report from the surveillance, epidemiology, and end-results program

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Advances in cancer care have resulted in improved outcomes, and increased number of cancer survivors. More than 80% of the children diagnosed with a pediatric malignancy survive beyond 5 years.1,2 This has resulted in a unique population of more than 300 000 adults who are childhood cancer survivors in 2005 in the United States alone3 and this number is expected to grow. Despite the improvement in survival, this population has increased burden of chronic comorbidities, especially cardiovascular disease.4–6
A significant number of childhood cancer survivors have at least one chronic health condition.7 Mertens et al.8 showed 10.8-fold excess in overall mortality among 5-year survivors of childhood. These patients were 8.2 times more likely to die of cardiac-related events making cardiovascular disease the third most common cause of mortality in this population. This higher risk of cardiovascular complications has been attributed to the long-term effects of the treatment therapies. Studies have shown congestive heart failure as a complication of both anthracyclines therapy and mediastinal radiation9,10 but they have also shown evidence of delayed cardiac impairment associated with these therapies as well.11,12
Guideline directed therapy and improvements in preventive cardiovascular care has drastically decreased cardiovascular mortality (CVM) in the general population. We have previously studied the temporal CVM trends among young adults (age 20–49) with Hodgkin's lymphoma and other types of malignancies. These studies showed improvement over the past decades.13,14 However, it is unclear if this improvement in cardiovascular outcomes applies to an even younger population. Thus, we sought to describe the trends in cardiovascular mortality (CVM) among childhood cancer survivors over the past four decades and to identify patient characteristics associated with increased risk in this population as well.

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