Cardiac Toxic Chemotherapy and Cancer Survivorship
With remarkable progress in cancer diagnosis and therapy, there are growing numbers of cancer survivors with almost 15 million current survivors in the United States. Because of the recognition that cardiovascular morbidity and mortality play an important
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Cardiac Toxic Chemotherapy and Cancer Survivorship Dava Szalda, Monica Ahluwalia, and Joseph R. Carver
Introduction With remarkable progress in cancer diagnosis and therapy, there are growing numbers of cancer survivors with almost 15 million current survivors in the United States whose number is estimated to grow to 19 million by 2024 [1, 2]. This population is composed of adult survivors of pediatric cancer and adult survivors of adult cancer. Because of the recognition that cardiovascular morbidity and mortality play an important role in outcomes of cancer survivors, especially those exposed to potentially cardiac toxic cancer therapy, understanding the unique cardiac needs of cancer survivors and existing evidence for care is essential to comprehensive cardio-oncology and general survivorship care. Cancer survivors are a heterogeneous group of patients in that they may have had pre-existing cardiac conditions or risk factors and varied treatment exposures that impact the risk of chemotherapeutic regimens and radiation exposure. Treatment information, along with current age, family history, and other modifiable risk factors (i.e., smoking or Electronic supplementary material: The online version of this chapter (doi:10.1007/978-3-31943096-6_11) contains supplementary material, which is available to authorized users. D. Szalda Abramson Cancer Center, Cancer Survivorship Program, Pediatric Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA e-mail: [email protected] M. Ahluwalia Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA e-mail: [email protected] J.R. Carver (*) Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 G.G. Kimmick et al. (eds.), Cardio-Oncology, DOI 10.1007/978-3-319-43096-6_11
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obesity), continue to be important considerations for patients. This heterogeneity, coupled with the potentially long asymptomatic latency period from treatment completion to symptomatic recognition, has meant that universally accepted guidelines for surveillance and prevention have been slow to develop. Adult survivors of pediatric cancer are addressed as a distinct group, and their care will also be covered in this chapter. Though childhood cancer is thankfully rare and childhood cancer survivors make up a small percentage of the overall number of cancer survivors, childhood cancer survivors are growing rapidly in number. Over 80 % of children diagnosed with cancer today will be cured [3]. For these survivors, treatment regimens, particularly treatment intensity, is distinct from treatment of adult cancers, and these survivors ideally have decades of survivorship in which they are increasingly vulnerable to cardiovascular disease. Indeed, the Childhood Cancer Survivor Study, the largest and most complete cohort study of childhood cancer survivors, has found that childhood cancer s
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