Early detection of cardiac dysfunction in childhood cancer survivors; a DCOG LATER study

The survival of children with cancer has improved considerably over the last decades. Nevertheless, there is a great concern about the long-term side effects of their treatment. Our previous study showed that the estimated risk of symptomatic cardiac disease is 9.6%, 40 years after treatment. Known treatment related risk factors for symptomatic cardiac events are anthracyclines, mitoxantrone and radiotherapy to the heart region. In the current Dutch guidelines, all survivors with these risk factors are screened by echocardiography every 3- 5 years for cardiac abnormalities, and are treated with heart failure medication when ejection fraction is <40% and/or if symptoms occur. To identify survivors at risk who might benefit from early treatment more evidence based knowledge is mandatory. In this line, we hypothesize that assessment of more sensitive echo- and electrocardiographic measurements, and/ or biomarkers will allow earlier recognition of asymptomatic patients with cardiovascular disease who are at higher risk of developing cardiac events, and provide also data on low risk groups.

This study will be part of the multidisciplinary Dutch Childhood Oncology Group (DCOG) research program for patient care and research into long-term effects after childhood cancer (LATER). We have identified a DCOG- LATER cohort of 6168 Dutch childhood cancer survivors (CCS) treated between 1963 and 2001. In the DCOG-LATER program all alive CCS will be invited for several sub-studies and diagnostic tests performed at the DCOG-LATER outpatient clinic. Our aims for the present cross-sectional cardiac DCOG-LATER study are 1) to estimate the magnitude of risk and risk factors for subclinical cardiovascular disease in CCS and 2) to estimate the diagnostic value of echo- and electrocardiographic parameters and biomarkers in detecting cardiac disease by performing these tests in a very large cohort. Furthermore, we will collect information on gender related morbidity, overall comorbidities and important confounders. The results of the study will enable us to develop more informed long-term follow-up screening guidelines and ultimately an intervention strategy aimed to deliver timely therapy to reduce cardiac events, either during the childhood cancer treatment or in the follow-up period.

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