Adult Survivors of Childhood Cancer Have Significant Levels of Impaired Cardiorespiratory Fitness, Inflammatory Markers, and Poor Quality of Life Outcomes - European Medical Journal

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Adult Survivors of Childhood Cancer Have Significant Levels of Impaired Cardiorespiratory Fitness, Inflammatory Markers, and Poor Quality of Life Outcomes

1 Mins
Cardiology
Authors:
C. McCune,1,2 C. Watson,2 M. Harbinson,1,2 A. McCarthy,3 R. Johnston,3 L. Dixon1,2

1. Department of Cardiology, Belfast Health and Social Care Trust, UK
2. Wellcome-Wolfson Institute of Experimental Medicine, Queen’s University Belfast, UK
3. Royal Belfast Hospital for Sick Children, UK

*Correspondence to [email protected]
Disclosure:

The authors have declared no conflicts of interest.

Citation:
EMJ Cardiol. ;11[1]:31-32. DOI/10.33590/emjcardiol/10306774. https://doi.org/10.33590/emjcardiol/10306774.
Keywords:
Anthracycline, cardio-oncology, survivors of childhood cancer.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND AND AIMS

Almost two-thirds of the 35,000 children diagnosed with cancer in Europe each year are treated with anthracycline chemotherapy.1 Despite improved survival rates, this therapy is responsible for symptomatic heart failure in up to 10% of patients decades after treatment.2 Furthermore, emerging evidence suggests that the late effects of the drug extend beyond systolic impairment.3,4

MATERIALS AND METHODS

Queen’s University Belfast, UK, conducted a study of 86 adult survivors of childhood cancer who were treated with over 100 mg/m2 doxorubicin equivalent. Each participant completed a 36-Item Short Form Health Survey (SF36) questionnaire to assess quality of life compared with Irish normative data.5,6 A 6-minute walk test (6MWT) was performed, and per cent predicted values were calculated, adjusted for age, sex, weight, and height.7,8 Cardiac biomarker analysis (wide-range C-reactive protein [wrCRP], N-terminal prohormone of brain natriuretic peptide, and troponin T), and cardiac imaging with echocardiography and MRI were performed.

Of the 86 survivors of childhood cancer studied, 55% were male, with an average age of 28 years (range: 18–53 years). The average anthracycline dose administered was 270 mg/m2 (108–705 mg/m2).

Echocardiography demonstrated that 16% had an ejection fraction of <53%, and 29% had a global longitudinal strain of <-18%. A noteworthy 70% of these survivors achieved the National Health Service (NHS) exercise benchmarks.9

Cardiorespiratory fitness, as measured by 6MWT, was below the lower limit of normal (<80% predicted) in 40% (34) of patients. In terms of quality of life, survivors of childhood cancer consistently underperformed against the standard, especially in general health (abnormal in 20% of participants), mental health (16%), and physical functioning (13%). Wide range C-reactive protein fell within the low cardiovascular risk category (<1 mg/L) in 31 patients, medium risk (1–3 mg/L) in 27 patients, and high risk (>3 mg/L) in 28 of the 86 patients.10

RESULTS

Outcomes varied by exercise habit. Inactive survivors of childhood cancer displayed abnormal wrCRP levels (p=0.002), underperformed in the 6MWT (p=0.002), and showed diminished indexed stroke volumes in MRI results (p=0.015) compared with participants who undertook regular exercise. A positive relationship was observed between the amount of exercise (measured in minutes per week) and improved 6MWT, fractional shortening, and septal E/e’ (all p<0.05). Those engaging in intense physical activity exhibited improved outcomes in 6MWT and quality of life metrics, as well as reduced frailty, wrCRP, N-terminal prohormone of brain natriuretic peptide, and global longitudinal strain (all p<0.05).

CONCLUSION

In conclusion, anthracycline chemotherapy treatment for childhood cancer is associated with abnormal cardiac imaging, but also an increased prevalence of impaired cardiorespiratory fitness, inflammation, and impaired quality of life in every domain. It remains uncertain whether sedentary behaviour results from cardiotoxicity, or if exercise counteracts its effects. This field warrants further exploration.

References
Vassal G et al.; ENCCA Long-term Sustainability (LTS) Working Group. The SIOPE strategic plan: a European cancer plan for children and adolescents. 2015. Available at: https://discovery.ucl.ac.uk/id/eprint/1529282/1/Vassal_SIOPE%20strategic%20plan%20PUBLISHED%20REPORT.pdf. Last accessed: 22 August 2023. Lieke Feijen EAM et al.; DCOG-LATER Study Group. Risk and temporal changes of heart failure among 5-year childhood cancer survivors: a DCOG-LATER study. J Am Heart Assoc. 2019;8(1):e009122. Lipshultz SE et al. Cardiovascular disease in adult survivors of childhood cancer. Annu Rev Med. 2015;66:161-76. Foulkes SJ et al. Exercise for the prevention of anthracycline-induced functional disability and cardiac dysfunction: the BREXIT study. Circulation. 2023;147(7):532-45. Blake C et al. The Short Form 36 (SF-36) Health Survey: normative data for the Irish population. Ir J Med Sci. 2000;169(3):195-200. Rand Corporation. 36-Item Short Form Survey from the RAND Medical Outcomes Study. Available at: https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form.html. Last accessed: 22 August 2023.. American Thoracic Society (ATS). ATS statement: guidelines for the six-minute walk test. 2002. Available at: https://www.atsjournals.org/doi/epdf/10.1164/ajrccm.166.1.at1102?role=tab. Last accessed: 22 August 2023. Enright PL. The six-minute walk test. Respir Care. 2003;48(8):783-5. National Health Service (NHS). Physical activity guidelines for adults aged 19 to 64. Available at: https://www.nhs.uk/live-well/exercise/exercise-guidelines/physical-activity-guidelines-for-adults-aged-19-to-64/. Last accessed: 22 August 2023. Ridker PM. C-reactive protein, inflammation, and cardiovascular disease. Tex Heart Inst J. 2005;32(3):384-6.

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