Cardiovascular disease in Adult Life after Childhood Cancer in Scandinavia: A population-based cohort study of 32,308 one-year survivors

Thorgerdur Gudmundsdottir, Jeanette F. Winther, Sofie de Fine Licht, Trine G. Bonnesen, Peter H. Asdahl, Laufey Tryggvadottir, Harald Anderson, Finn Wesenberg, Nea Malila, Henrik Hasle, Jorgen H. Olsen

Research output: Contribution to journalArticlepeer-review

56 Citations (SciVal)

Abstract

The lifetime risk for cardiovascular disease in a large cohort of childhood cancer survivors has not been fully assessed. In a retrospective population-based cohort study predicated on comprehensive national health registers, we identified a cohort of 32,308 one-year survivors of cancer diagnosed before the age of 20 in the five Nordic countries between the start of cancer registration in the 1940s and 1950s to 2008; 211,489 population comparison subjects were selected from national population registers. Study subjects were linked to national hospital registers, and the observed numbers of first hospital admission for cardiovascular disease among survivors were compared with the expected numbers derived from the population comparison cohort. Cardiovascular disease was diagnosed in 2,632 childhood cancer survivors (8.1%), yielding a standardized hospitalization rate ratio (RR) of 2.1 (95% CI 2.0-2.2) and an overall absolute excess risk (AER) of 324 per 100,000 person-years. At the end of follow-up 12% of the survivors were50 years of age and 4.5%60 years of age. Risk estimates were significantly increased throughout life, with an AER of approximate to 500-600 per 100,000 person-years at age40. The highest relative risks were seen for heart failure (RR, 5.2; 95% CI 4.5-5.9), valvular dysfunction (4.6; 3.8-5.5) and cerebrovascular diseases (3.7; 3.4-4.1). Survivors of hepatic tumor, Hodgkin lymphoma and leukemia had the highest overall risks for cardiovascular disease, although each main type of childhood cancer had increased risk with different risk profiles. Nordic childhood cancer survivors are at markedly increased risk for cardiovascular disorders throughout life. These findings indicate the need for preventive interventions and continuous follow-up for this rapidly growing population. What's new? The long-term effects of cancer treatment in childhood cancer survivors can be serious, and more research is needed to fully investigate the relationship between treatment and chronic disease in aging survivors. This retrospective population-based cohort study focused on cardiovascular late effects among childhood cancer survivors in the five Nordic countries. Survivors were found to be at significantly increased risk for cardiovascular disease throughout their lives. Relative risk was highest for heart failure, valvular dysfunction, and cerebrovascular diseases. Overall, survivors had a twofold increased lifetime risk for hospitalization for cardiovascular disease.
Original languageEnglish
Pages (from-to)1176-1186
JournalInternational Journal of Cancer
Volume137
Issue number5
DOIs
Publication statusPublished - 2015

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems
  • Cancer and Oncology

Keywords

  • childhood cancer
  • late complications
  • cardiovascular disease
  • hospitalizations
  • clinical epidemiology

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