Late Cardiac Events after Childhood Cancer: Methodological Aspects of the Pan-European Study PanCareSurFup

Elizabeth A M Feijen, Anna Font-Gonzalez, Elvira C van Dalen, Helena J H van der Pal, Raoul C Reulen, David L Winter, Claudia E Kuehni, Riccardo Haupt, Daniela Alessi, Julianne Byrne, Edit Bardi, Zsuzsanna Jakab, Desiree Grabow, Stanislaw Garwicz, Momcilo Jankovic, Gill A Levitt, Roderick Skinner, Lorna Zadravec Zaletel, Lars Hjorth, Wim J E Tissing, Florent de Vathaire, Mike M Hawkins, Leontien C M Kremer, PanCareSurFup consortium, Elizabeth A M Feijen, Anna Font-Gonzalez, Elvira C van Dalen, Helena J H van der Pal, Raoul C Reulen, David L Winter, Claudia E Kuehni, Riccardo Haupt, Daniela Alessi, Julianne Byrne, Edit Bardi, Zsuzsanna Jakab, Desiree Grabow, Stanislaw Garwicz, Momcilo Jankovic, Gill A Levitt, Roderick Skinner, Lorna Zadravec Zaletel, Lars Hjorth, Wim J E Tissing, Florent de Vathaire, Mike M Hawkins, Leontien C M Kremer, PanCareSurFup consortium

Abstract

Background and aim: Childhood cancer survivors are at high risk of long-term adverse effects of cancer and its treatment, including cardiac events. The pan-European PanCareSurFup study determined the incidence and risk factors for cardiac events among childhood cancer survivors. The aim of this article is to describe the methodology of the cardiac cohort and nested case-control study within PanCareSurFup.

Methods: Eight data providers in Europe participating in PanCareSurFup identified and validated symptomatic cardiac events in their cohorts of childhood cancer survivors. Data on symptomatic heart failure, ischemia, pericarditis, valvular disease and arrhythmia were collected and graded according to the Criteria for Adverse Events. Detailed treatment data, data on potential confounders, lifestyle related risk factors and general health problems were collected.

Results: The PanCareSurFup cardiac cohort consisted of 59,915 5-year childhood cancer survivors with malignancies diagnosed between 1940 and 2009 and classified according to the International Classification of Childhood Cancer 3. Different strategies were used to identify cardiac events such as record linkage to population/ hospital or regional based databases, and patient- and general practitioner-based questionnaires.

Conclusion: The cardiac study of the European collaborative research project PanCareSurFup will provide the largest cohort of 5-year childhood cancer survivors with systematically ascertained and validated data on symptomatic cardiac events. The result of this study can provide information to minimize the burden of cardiac events in childhood cancer survivors by tailoring the follow-up of childhood cancer survivors at high risk of cardiac adverse events, transferring this knowledge into evidence-based clinical practice guidelines and providing a platform for future research studies in childhood cancer patients. .

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Robison LL, Hudson MM. Survivors of childhood and adolescent cancer: life-long risks and responsibilities. Nature reviews Cancer. 2014;14(1):61–70. 10.1038/nrc3634 .
    1. Geenen MM, Cardous-Ubbink MC, Kremer LC, Bos vd C., Pal vd H. J. H., Heinen RC, et al. Medical Assessment of Adverse Health Outcomes in Long-term Survivors of Childhood Cancer. JAMA. 2007;297(24):2705–15.
    1. Hudson MM, Ness KK, Gurney JG, Mulrooney DA, Chemaitilly W, Krull KR, et al. Clinical Ascertainment of Health Outcomes Among Adults Treated for Childhood Cancer. JAMA. 2013;309(22):2371–81. 10.1001/jama.2013.6296
    1. Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic Health Conditions in Adult Survivors of Childhood Cancer. New England Journal of Medicine. 2006;355:1572–82.
    1. Mulrooney DA, Yeazel MW, Kawashima T, Mertens AC, Mitby P, Stovall M, et al. Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort. Bmj. 2009;339:b4606 Epub 2009/12/10. 10.1136/bmj.b4606
    1. Pal vd H. J., Dalen v E. C., Delden v E., Dijk v I. W., Kok WE, Geskus RB, et al. High risk of symptomatic cardiac events in childhood cancer survivors. J Clin Oncol. 2012;30(13):1429–37. Epub 2012/04/05. 10.1200/JCO.2010.33.4730 .
    1. Garwicz S, Anderson H, Olsen JH, Winther JF, Sankila R, Langmark F, et al. Late and very late mortality in 5-year survivors of childhood cancer: changing pattern over four decades—experience from the Nordic countries. International journal of cancer Journal international du cancer. 2012;131(7):1659–66. 10.1002/ijc.27393 .
    1. Reulen RC, Winter DL, Frobisher C, Lancashire ER, Stiller CA, Jenney ME, et al. Long-term Cause-Specific Mortality Among Survivors of Childhood Cancer. JAMA. 2010;304(2):172–9. 10.1001/jama.2010.923
    1. Tukenova M, Guibout C, Oberlin O, Doyon F, Mousannif A, Haddy N, et al. Role of cancer treatment in long-term overall and cardiovascular mortality after childhood cancer. J Clin Oncol. 2010;28(8):1308–15. 10.1200/JCO.2008.20.2267 .
    1. Hoff DD, Rozencweig M, Layard M, Slavik M, Muggia FM. Daunomycine-induced cardiotoxicity in children and adults: a review of 110 cases. Am J Med. 1977;62:200–8.
    1. Hoff DD, Layard M, Basa P, Davis HL, von Hoff AL, Rozencweig M, et al. Risk factors for doxorubicin-induced congestive heart failure. Arch Intern Med. 1979;91:710–7.
    1. van der Pal HJ, van Dijk IW, Geskus RB, Kok WE, Koolen M, Sieswerda E, et al. Valvular Abnormalities Detected by Echocardiography in 5-Year Survivors of Childhood Cancer: A Long-Term Follow-Up Study. International journal of radiation oncology, biology, physics. 2014. 10.1016/j.ijrobp.2014.09.010 .
    1. Mulrooney DA, Nunnery SE, Armstrong GT, Ness KK, Srivastava D, Donovan FD, et al. Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma. Cancer. 2014;120(22):3536–44. 10.1002/cncr.28925
    1. Lipshultz S, Lipsitz SR, Mone SM, Goorin AM, Sallan SE, Sanders SP, et al. Female sex and higher drug dose as risk factors for late cardiotoxic effects of doxorubicin therapy for childhood cancer. N Engl J Med. 1995;332:1738–43.
    1. Armstrong GT, Oeffinger KC, Chen Y, Kawashima T, Yasui Y, Leisenring W, et al. Modifiable risk factors and major cardiac events among adult survivors of childhood cancer. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2013;31(29):3673–80. Epub 2013/09/05. 10.1200/JCO.2013.49.3205
    1. Blanco JG, Leisenring WM, Gonzalez-Covarrubias VM, Kawashima TI, Davies SM, Relling MV, et al. Genetic polymorphisms in the carbonyl reductase 3 gene CBR3 and the NAD(P)H:quinone oxidoreductase 1 gene NQO1 in patients who developed anthracycline-related congestive heart failure after childhood cancer. Cancer. 2008;112(12):2789–95. Epub 2008/05/07. 10.1002/cncr.23534 .
    1. Visscher H, Ross CJ, Rassekh SR, Barhdadi A, Dube MP, Al-Saloos H, et al. Pharmacogenomic prediction of anthracycline-induced cardiotoxicity in children. J Clin Oncol. 2012;30(13):1422–8. Epub 2011/09/09. 10.1200/JCO.2010.34.3467 .
    1. Winther JF, Kenborg L, Byrne J, Hjorth L, Kaatsch P, Kremer LC, et al. Childhood cancer survivor cohorts in Europe. Acta oncologica. 2015:1–14. 10.3109/0284186X.2015.1008648 .
    1. NCI. Common Terminology Criteria for Adverse Events (CTCAE) 2010. V4.03:[Available from: .
    1. Feijen EAM, van der Pal HJ, van Dalen EC, Mulder RL, Bardi E, Kuehni C, et al. A new method to facilitate valid and consistent grading cardiac events in childhood cancer survivors using medical records. PloS one. 2014;9(7):e100432 10.1371/journal.pone.0100432
    1. Geskus RB. Cause-specific cumulative incidence estimation and the fine and gray model under both left truncation and right censoring. Biometrics. 2011;67(1):39–49. 10.1111/j.1541-0420.2010.01420.x .
    1. Badouna AN, Veres C, Haddy N, Bidault F, Lefkopoulos D, Chavaudra J, et al. Total heart volume as a function of clinical and anthropometric parameters in a population of external beam radiation therapy patients. Physics in medicine and biology. 2012;57(2):473–84. 10.1088/0031-9155/57/2/473 .
    1. Lipshultz SE, Lipsitz SR, Sallan SE, Dalton VM, Mone SM, Gelber RD, et al. Chronic progressive cardiac dysfunction years after doxorubicin therapy for childhood acute lymphoblastic leukemia. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2005;23(12):2629–36. Epub 2005/04/20. 10.1200/JCO.2005.12.121 .
    1. Behar C, Such S, Benoit Y, Robert A, Vilmer E., Boutard P, et al. Mitoxantrone-Containing Regimen for Treatment of Childhood acute Leukemia (AML) and Analysis of Prognostic Factors: Results of the EORTC Children Leukemia Cooperative Study 58872. Medical and Pediatric Oncology. 1996;26:173–9.
    1. Dalen v EC, Pal vd HJ, Bakker PJ, Caron HN, Kremer LC. Cumulative incidence and risk factors of mitoxantrone-induced cardiotoxicity in children: a systematic review. European journal of cancer. 2004;40(5):643–52. Epub 2004/03/11. 10.1016/j.ejca.2003.12.006 .
    1. Tassinari D, Sartori S, Drudi G, Panzini I, Gianni L, Pasquini E, et al. Cardiac arrhythmias after cisplatin infusion: Three case reports and a review of the literature. Annals of Oncology. 1997;8:1263–7.
    1. Green DM, Nolan VG, Goodman PJ, Whitton JA, Srivastava D, Leisenring WM, et al. The cyclophosphamide equivalent dose as an approach for quantifying alkylating agent exposure: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer. 2014;61(1):53–67. 10.1002/pbc.24679
    1. Goldberg MA, Antin JH, Guinan EC, J.M. R. Cyclophosphamide Cardiotoxicity: An Analysis of Dosing as a Risk Factor. Blood. 1986;68(5):1114–8.
    1. Gottdiener JS, Appelbaum FR, Ferrans VJ, Deisseroth A, J. Z. Cardiotoxicity associated with high dose cyclophosphamide therapy. Arch Intern Med. 1981;141:758–63.
    1. Landy DC, Miller TL, Lipsitz SR, Lopez-Mitnik G, Hinkle AS, Constine LS, et al. Cranial irradiation as an additional risk factor for anthracycline cardiotoxicity in childhood cancer survivors: an analysis from the cardiac risk factors in childhood cancer survivors study. Pediatr Cardiol. 2013;34(4):826–34. 10.1007/s00246-012-0539-6
    1. Hummel YM, Hooimeijer HL, Zwart N, Tissing WJ, Gietema JA, Voors AA, et al. Long-term cardiac abnormalities after cranial radiotherapy in childhood cancer survivors. Acta oncologica. 2015;54(4):515–21. 10.3109/0284186X.2014.969845 .
    1. Kleinbaum DG, Klein M. Logistic regression Third ed. Gail M, Krickeberg K, Samet JM, Tsiatis A, Wong W, editors: Springer; 2010.
    1. Steliarova-Foucher E, Stiller C, Lacour B, Kaatsch P. International Classification of Childhood Cancer, third edition. Cancer. 2005;103(7):1457–67. 10.1002/cncr.20910 .
    1. Garwicz S, Anderson H, Olsen JH, Winther JF, Sankila R, Langmark F, et al. Late and very late mortality in 5-year survivors of childhood cancer: changing pattern over four decades experience from the Nordic countries. International journal of cancer Journal international du cancer. 2012;131(7):1659–66. 10.1002/ijc.27393 .
    1. Green DM, Grigoriev YA, Takashima JR, Norkool PA, D'Angio GJ, Breslow NE. Congestive heart failure after treatment for wilms’ tumor: A report from the National Wilms’ Tumor Study Group. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2001;19:1926–34.
    1. Hudson MM, Rai SN, Nunez C, Merchant TE, Marina NM, Zalamea N, et al. Noninvasive evaluation of late anthracycline cardiac toxicity in childhood cancer survivors. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2007;25(24):3635–43. Epub 2007/08/21. 10.1200/JCO.2006.09.7451 .
    1. Kero AE, Jarvela LS, Arola M, Malila N, Madanat-Harjuoja LM, Matomaki J, et al. Cardiovascular morbidity in long-term survivors of early-onset cancer: a population-based study. International journal of cancer Journal international du cancer. 2014;134(3):664–73. 10.1002/ijc.28385 .
    1. Gudmundsdottir T, J FW, de Fine Licht S, T GB, P HA, Tryggvadottir L, et al. Cardiovascular disease in Adult Life after Childhood Cancer in Scandinavia: A population-based cohort study of 32,308 one-year survivors. International journal of cancer Journal international du cancer. 2015. 10.1002/ijc.29468 .
    1. Peduzzi P, Concato J, Feinstein AR, Holford TR. Importance of events per independent variable in proportinal hazards regression analysis II. Accuracy and precision of regression estimates. j Clin Epidemiol. 1995;48(12):1503–10.
    1. Kremer LC, Mulder RL, Oeffinger KC, Bhatia S, Landier W, Levitt G, et al. A worldwide collaboration to harmonize guidelines for the long-term follow-up of childhood and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Pediatr Blood Cancer. 2013;60(4):543–9. 10.1002/pbc.24445
    1. Armenian SH, Hudson MM, Mulder RL, Chen MH, Constine LS, Dwyer M, et al. Recommendations for cardiomyopathy surveillance for survivors of childhood cancer: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol. 2015;16(3):e123–e36. 10.1016/s1470-2045(14)70409-7

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