Published online January 10, 2008
PEDIATRICS (doi:10.1542/peds.2007-0575)
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SPECIAL ARTICLE

Monitoring for Cardiovascular Disease in Survivors of Childhood Cancer: Report From the Cardiovascular Disease Task Force of the Children's Oncology Group

Sadhna M. Shankar, MD, MPHa, Neyssa Marina, MDb, Melissa M. Hudson, MDc, David C. Hodgson, MDd, M. Jacob Adams, MD, MPHe, Wendy Landier, RN, MSN, CPNPf, Smita Bhatia, MD, MPHf, Kathleen Meeske, PhD, RNg, Ming Hui Chen, MD, MMSch, Karen E. Kinahan, MS, APRNi, Julia Steinberger, MD, MSj and David Rosenthal, MDk

a Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
b Division of Pediatric Hematology/Oncology, Department of Pediatrics
k Division of Pediatric Cardiology, Stanford University, Palo Alto, California
c Pediatric Hematology/Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
d Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
e Division of Epidemiology, Community and Preventive Medicine, University of Rochester, Rochester, New York
f Division of Population Sciences, City of Hope Cancer Center, Duarte, California
g Children's Center for Cancer and Blood Diseases, Childrens Hospital Los Angeles, Los Angeles, California
h Division of Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts
i STAR Survivorship Program, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
j Division of Pediatric Cardiology, University of Minnesota, Minneapolis, Minnesota

Curative therapy for childhood cancer has improved significantly in the last 2 decades such that, at present, ~80% of all children with cancer are likely to survive ≥5 years after diagnosis. Prevention, early diagnosis, and treatment of long-term sequelae of therapy have become increasingly more significant as survival rates continue to improve. Cardiovascular disease is a well-recognized cause of increased late morbidity and mortality among survivors of childhood cancer. The Children's Oncology Group Late Effects Committee and Nursing Discipline and Patient Advocacy Committee have recently developed guidelines for follow-up of long-term survivors of pediatric cancer. A multidisciplinary task force critically reviewed the existing literature to evaluate the evidence for the cardiovascular screening recommended by the Children's Oncology Group guidelines. In this review we outline the clinical manifestations of late cardiovascular toxicities, suggest modalities and frequency of monitoring, and address some of the controversial and unresolved issues regarding cardiovascular disease in childhood cancer survivors.

Key Words: cardiomyopathy • anthracyclines • radiation therapy • cancer • survivor

Abbreviations: COG—Children's Oncology Group • CHF—congestive heart failure • FS—fractional shortening • EF—ejection fraction • LVSD—left-ventricular systolic dysfunction • HL—Hodgkin's lymphoma

Accepted Jun 15, 2007.




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