Cardiac Outcomes in Adult Survivors of Childhood Cancer Exposed to Cardiotoxic Therapy: A Cross-sectional Study

Ann Intern Med. 2016 Jan 19;164(2):93-101. doi: 10.7326/M15-0424. Epub 2016 Jan 5.


Background: Studies of cardiac disease among adult survivors of childhood cancer have generally relied on self-reported or registry-based data.

Objective: To systematically assess cardiac outcomes among survivors of childhood cancer.

Design: Cross-sectional study.

Setting: St. Jude Children's Research Hospital.

Patients: 1853 adult survivors of childhood cancer, aged 18 years or older, who received cancer-related cardiotoxic therapy at least 10 years earlier.

Measurements: Baseline history and physical examination, fasting metabolic and lipid panels, echocardiography, electrocardiography, and 6-minute walk test.

Results: One half of the survivors (52.3%) were men with a median age of 8 years (range, 0 to 24 years) at cancer diagnosis and 31 years (range, 18 to 60 years) at evaluation. Cardiomyopathy was present in 7.4% survivors (newly identified at the time of evaluation in 4.7%), coronary artery disease in 3.8% (newly identified in 2.2%), valvular regurgitation or stenosis in 28.0% (newly identified in 24.8%), and conduction or rhythm abnormalities in 4.4% (newly identified in 1.4%). Nearly all survivors were asymptomatic. The prevalence of cardiac conditions increased with age at evaluation, ranging from 3% to 24% among survivors aged 30 to 39 years to 10% to 37% among those aged 40 years or older. In multivariable analysis, survivors exposed to anthracycline doses of 250 mg/m2 or more had greater odds of cardiomyopathy (odds ratio, 2.7 [95% CI, 1.1 to 6.9]) than those who were not exposed. Survivors exposed to heart radiation also had increased odds of cardiomyopathy (odds ratio, 1.9 [CI, 1.1 to 3.7]) compared with those who were not exposed. Radiation exposure greater than 1500 cGy with any anthracycline exposure conferred the greatest odds for valve findings.

Limitations: Sixty-one percent of survivors exposed to anthracycline chemotherapy or cardiac-directed radiation participated. A comparison group and longitudinal assessments were not available.

Conclusion: Cardiovascular screening identified considerable subclinical disease among adult survivors of childhood cancer.

Primary funding source: National Cancer Institute, American Lebanese Syrian Associated Charities.

Trial registration: NCT00760656.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Anthracyclines / adverse effects
  • Antineoplastic Agents / adverse effects*
  • Cardiotoxins / adverse effects*
  • Cardiovascular Diseases / chemically induced
  • Cardiovascular Diseases / epidemiology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / drug therapy*
  • Neoplasms / radiotherapy
  • Prevalence
  • Prospective Studies
  • Radiotherapy / adverse effects
  • Risk Factors
  • Survivors*
  • United States / epidemiology
  • Young Adult


  • Anthracyclines
  • Antineoplastic Agents
  • Cardiotoxins

Associated data