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PPH - Official PPH Blog

Heart disease and childhood cancer might not be linked anymore

For years it was thought that children who fought and survived cancer were at higher risk of heart diseases when they grew up. However, recent study by the Childhood Cancer Survivor Study says otherwise. Read on to know more about the risk of heart disease in childhood cancer survivors:


What does the study tell us?

A large study from Britain, was carried with more than 23,000 children to know about their risk of developing heart diseases in the future. This cohort study involved following the children with childhood cancers, for more than 20 years. The goal of this study was to find how effective the efforts were to reduce the long-term mortality associated with anti-cancer treatment.

Previously, large scale studies showed substantial premature mortality in adult survivors of childhood cancers. In fact, in another cohort British study, the mortality rates were as high as 30 percent, which was far higher than the expected 6 percent.

Chemotherapies such as those with anthracyclines, among others, are associated with weakening of heart muscle; moreover, radiation exposure is linked to structural damage in heart valves, arteries as well as cardiac arrhythmias. 


Following such high mortality rates in adulthood, efforts were made to lower the exposure of children to toxic chemotherapeutic agents, as well as radiotherapy. As a result of these efforts, the risk of Coronary Artery Disease (CAD) fell steadily, between the 1970s and 1990s.


Between these years, the exposure of radiation therapy also decreased from 77 percent to 40 percent; however, many of these patients were those of Hodgkin lymphoma. On the other hand, patients with neuroblastoma had worsening of heart diseases because of intensification of treatments between the years 1980 and 1990.


The study showed that despite the efforts made to reduce the risk for cancer survivors, by modification of chemotherapy, and reduction of radiation exposure, the risk remains high in childhood cancer survivors. As such, about half of these survivors develop some degree of cardiovascular ill-health within 20 years of treatment. However, these numbers are dropping steadily through the years, as efforts to reduce cardiotoxicity of treatment are working.


What conditions worsen the risk of cardiovascular diseases?

As mentioned before, chemotherapy agents such as anthracyclines and radiation therapy are associated with negative impact on heart health. If someone has undergone treatment with these agents, they should ensure that they reduce the stress to the heart. Certain drugs can increase strain on the heart post-treatment, including diet pills, cocaine, ephedra, ma huang and drugs that enhance performance.


hearth disease


The stress on the heart is not limited to just drugs; certain types of exercises can also increase the strain on the heart. Therefore, cancer survivors should always consult a professional prior to starting a strenuous exercise program. Similarly, survivors who want to engage in sports on a professional level, or varsity team sports should follow certain guidelines and plans set by their healthcare provider to keep their health in check. 


What should cancer survivors do?

Despite the efforts to modify therapy to pose less cardiovascular risk, and monitor the health of people who have previously battled cancer, the risk remains high in cancer patients of all ages. Therefore, cancer survivors should keep a strict check on their cardiovascular health, exercise regularly, and never miss their routine check-ups. In particular, they should get screened for high cholesterol and high blood pressures to prevent the long-term risk of cardiovascular complications.


For children treated with anthracycline, an annual health check-up is must. For those survivors entering a long-term follow-up plan, an ECG and an echocardiogram is recommended at the first visit.


Those patients who underwent radiation therapy at a dose of 30 Gy, along with anthracycline chemotherapy, or 40 Gy radiotherapy alone, a stress test should be done 5 to 10 years later. Furthermore, blood tests must be done in such survivors to check for cardiac risk factors, including fasting glucose level and lipid profile every 3 to 5 years.


For female cancer survivors, who are planning pregnancy or are already pregnant, additional evaluation by a cardiologist is recommended. Along with this a complete regular consultation with a gynecologist is also very important. If you are a cancer survivor, and are pregnant then you should keep visiting a hospital such as Islamabad specialist clinic, since it has multiple gynecologists and cardiologists working on its panel.


How to prevent heart problems?

For someone with an unhealthy lifestyle, there is risk of cardiovascular disease even without childhood cancer. Factors that can increase the risk of heart disease even in non-cancer patients include: smoking, obesity, high-fat diet and sedentary lifestyle. However, if these risk factors are found in the life of someone who survived childhood cancer, then the risk of cardiovascular disease increases many folds.


Individuals can decrease their risk of heart disease by avoiding smoke (even second-hand smoke), limiting their intake of fatty food, maintaining a healthy body mass index and doing moderate exercise for at least 30 minutes every day. For those who are diabetic or pre-diabetic, it is important to maintain their blood sugar level, improve their dietary habits and be compliant to the instructions of the healthcare provider.


In case of cardiovascular symptoms—such as dizziness, sweating, piercing chest pain, swollen feet or ankles, cough with sputum, difficulty in lying straight, and irregular heart beat a hospital with proper cardiac facilities such as Hameed Latif Hospital should be visited and prompt treatment by the healthcare provider should be sought.