Abstract Background Childhood cancer survivors (CCSs) face a high risk of long-term cardiovascular complications(1), influenced by modifiable cardiovascular risk factors(2). Health related limitations may affect individual ability to establish and maintain a healthy life style. Current guidelines advocate regular cardiovascular surveillance, stratified by previous cancer treatment(2). In this prospective pilot study of young adult CCSs with normal LVEF (≥50%) and follow up time ≥5 years after childhood cancer, we have assessed cardiovascular function, life style and health related quality of life. Methods Cardiovascular function (echocardiography, ankle brachial index (ABI) and blood pressure), endothelial function (EndoPAT), metabolic status (biomarkers), questionnaires on life style factors and health related quality of life (RAND-36(3)) were analysed. The study included 18 patients (7 females, 9 males), March 2023-September 2024. Median age at inclusion was 26 years (range 22-39 years) and median follow up time from primary cancer diagnosis, 14.7 years (range 6.8-33.5 years). Median age at primary cancer diagnosis was 12.6 years (range 1.9-17.7 years). The high-risk-group (defined as cumulative doxorubicin equivalent doses(4) ≥250 mg/m2 or chest radiotherapy ≥15 Gy, or a combination of doxorubicin doses ≥100 mg/m2 and any chest radiotherapy) included 13 patients with median cumulative doxorubicin equivalent dose 300 mg/m2 (range 80-810), including 6 patients with radiotherapy involving the heart, median dose 25 Gy (range 1.8-39.9) and 2 patients with total body irradiation. The non-high-risk group consisted of 5 patients with median cumulative doxorubicin equivalent dose 120 mg/m2 (range 0-240 mg/m2) and included one patient with cranial radiotherapy. Results Two high risk patients had slightly impaired ABI. Reactive hyperemia index (RHI) registered by EndoPAT, demonstrated normal median values in the high-risk and non-high-risk group (2.14 respectively 1.98, with 1.67 as cut-off for normal) and no difference in range (1.54-2.75 respectively 1.52-2.53). No patient with subnormal RHI had systolic blood pressure ≥140 mmHg. Overweight (BMI 25-29) was found in 33%. Physical activity levels were lower than recommended(5) in a majority: 10/18 reported less than 75 min of high level of physical activity, including 8 with less than 120 min of low intensity physical activity per week. Regular tobacco use was reported in 11/18 individuals (3 smoking, 8 snuff). Health related quality of life scores, RAND-36, indicated lower emotional role functioning (RE) scores (emotional limitations to engage in everyday life) in the CCS-groups when compared with corresponding age groups in established reference population(6) (Figure 1). Conclusion Our results highlight the importance of addressing lifestyle factors and quality of life in prospective studies, as this may be the heart of matter for optimizing cardiovascular outcomes in young adult CCSs with normal LVEF.
Alpman et al. (Fri,) studied this question.