Anthracycline chemotherapy and chest-directed radiotherapy pose significant cardiovascular risks in childhood cancer survivors, necessitating effective surveillance and management strategies.
This AHA scientific statement provides updated guidance on the cardiovascular toxicities of pediatric cancer treatments and recommends risk-based surveillance strategies for childhood cancer survivors.
The field of cardio-oncology has expanded over the past 2 decades to address the ever-increasing issues related to cardiovascular disease in patients with cancer and survivors. There is increasing recognition that nearly all cancer treatments pose some short- or long-term risk for development of cardiovascular disease and that pediatric patients with cancer may be especially vulnerable to cardiovascular disease because of young age at treatment and expected long life span afterward. Anthracycline chemotherapy and chest-directed radiotherapy are the most well-studied cardiotoxic therapies, and dose reduction, use of cardioprotection for anthracyclines, and modern radiotherapy approaches have contributed to improved cardiovascular outcomes for survivors. Newer treatments such as small-molecule inhibitors, antibody-based cytotoxic therapy, and immunotherapy have expanded options for previously difficult-to-treat cancers but have also revealed new cardiotoxic profiles. Application of effective surveillance strategies in patients with cancer and survivors has been a focus of practitioners and researchers, whereas the prevention and treatment of extant cardiovascular disease is still developing. Incorporation of new strategies in an equitable manner and appropriate transition from pediatric to adult care will greatly influence long-term health-related outcomes in the growing population of childhood cancer survivors at risk for cardiovascular disease.
“CVD in survivors of childhood cancer is more than just ventricular dysfunction, and includes metabolic effects, hypertension, arrhythmia, and thrombosis; understanding an individual's risk and establishing appropriate screening is a key component to patient care.”
Ryan et al. (2025) studied this question. Anthracycline chemotherapy and chest-directed radiotherapy pose significant cardiovascular risks in childhood cancer survivors, necessitating effective surveillance and management strategies.