Advanced

Cardiovascular disease in Adult Life after Childhood Cancer in Scandinavia: A population-based cohort study of 32,308 one-year survivors

Gudmundsdottir, Thorgerdur; Winther, Jeanette F.; Licht, Sofie de Fine; Bonnesen, Trine G.; Asdahl, Peter H.; Tryggvadottir, Laufey; Anderson, Harald LU ; Wesenberg, Finn; Malila, Nea and Hasle, Henrik, et al. (2015) In International Journal of Cancer 137(5). p.1176-1186
Abstract
The lifetime risk for cardiovascular disease in a large cohort of childhood cancer survivors has not been fully assessed. In a retrospective population-based cohort study predicated on comprehensive national health registers, we identified a cohort of 32,308 one-year survivors of cancer diagnosed before the age of 20 in the five Nordic countries between the start of cancer registration in the 1940s and 1950s to 2008; 211,489 population comparison subjects were selected from national population registers. Study subjects were linked to national hospital registers, and the observed numbers of first hospital admission for cardiovascular disease among survivors were compared with the expected numbers derived from the population comparison... (More)
The lifetime risk for cardiovascular disease in a large cohort of childhood cancer survivors has not been fully assessed. In a retrospective population-based cohort study predicated on comprehensive national health registers, we identified a cohort of 32,308 one-year survivors of cancer diagnosed before the age of 20 in the five Nordic countries between the start of cancer registration in the 1940s and 1950s to 2008; 211,489 population comparison subjects were selected from national population registers. Study subjects were linked to national hospital registers, and the observed numbers of first hospital admission for cardiovascular disease among survivors were compared with the expected numbers derived from the population comparison cohort. Cardiovascular disease was diagnosed in 2,632 childhood cancer survivors (8.1%), yielding a standardized hospitalization rate ratio (RR) of 2.1 (95% CI 2.0-2.2) and an overall absolute excess risk (AER) of 324 per 100,000 person-years. At the end of follow-up 12% of the survivors were50 years of age and 4.5%60 years of age. Risk estimates were significantly increased throughout life, with an AER of approximate to 500-600 per 100,000 person-years at age40. The highest relative risks were seen for heart failure (RR, 5.2; 95% CI 4.5-5.9), valvular dysfunction (4.6; 3.8-5.5) and cerebrovascular diseases (3.7; 3.4-4.1). Survivors of hepatic tumor, Hodgkin lymphoma and leukemia had the highest overall risks for cardiovascular disease, although each main type of childhood cancer had increased risk with different risk profiles. Nordic childhood cancer survivors are at markedly increased risk for cardiovascular disorders throughout life. These findings indicate the need for preventive interventions and continuous follow-up for this rapidly growing population. What's new? The long-term effects of cancer treatment in childhood cancer survivors can be serious, and more research is needed to fully investigate the relationship between treatment and chronic disease in aging survivors. This retrospective population-based cohort study focused on cardiovascular late effects among childhood cancer survivors in the five Nordic countries. Survivors were found to be at significantly increased risk for cardiovascular disease throughout their lives. Relative risk was highest for heart failure, valvular dysfunction, and cerebrovascular diseases. Overall, survivors had a twofold increased lifetime risk for hospitalization for cardiovascular disease. (Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
childhood cancer, late complications, cardiovascular disease, hospitalizations, clinical epidemiology
in
International Journal of Cancer
volume
137
issue
5
pages
1176 - 1186
publisher
John Wiley & Sons
external identifiers
  • wos:000356429000018
  • scopus:84931563118
ISSN
0020-7136
DOI
10.1002/ijc.29468
language
English
LU publication?
yes
id
92de21ab-7bf1-480b-8f71-2baac7bffa92 (old id 7596540)
date added to LUP
2015-08-03 10:10:31
date last changed
2017-09-10 03:03:16
@article{92de21ab-7bf1-480b-8f71-2baac7bffa92,
  abstract     = {The lifetime risk for cardiovascular disease in a large cohort of childhood cancer survivors has not been fully assessed. In a retrospective population-based cohort study predicated on comprehensive national health registers, we identified a cohort of 32,308 one-year survivors of cancer diagnosed before the age of 20 in the five Nordic countries between the start of cancer registration in the 1940s and 1950s to 2008; 211,489 population comparison subjects were selected from national population registers. Study subjects were linked to national hospital registers, and the observed numbers of first hospital admission for cardiovascular disease among survivors were compared with the expected numbers derived from the population comparison cohort. Cardiovascular disease was diagnosed in 2,632 childhood cancer survivors (8.1%), yielding a standardized hospitalization rate ratio (RR) of 2.1 (95% CI 2.0-2.2) and an overall absolute excess risk (AER) of 324 per 100,000 person-years. At the end of follow-up 12% of the survivors were50 years of age and 4.5%60 years of age. Risk estimates were significantly increased throughout life, with an AER of approximate to 500-600 per 100,000 person-years at age40. The highest relative risks were seen for heart failure (RR, 5.2; 95% CI 4.5-5.9), valvular dysfunction (4.6; 3.8-5.5) and cerebrovascular diseases (3.7; 3.4-4.1). Survivors of hepatic tumor, Hodgkin lymphoma and leukemia had the highest overall risks for cardiovascular disease, although each main type of childhood cancer had increased risk with different risk profiles. Nordic childhood cancer survivors are at markedly increased risk for cardiovascular disorders throughout life. These findings indicate the need for preventive interventions and continuous follow-up for this rapidly growing population. What's new? The long-term effects of cancer treatment in childhood cancer survivors can be serious, and more research is needed to fully investigate the relationship between treatment and chronic disease in aging survivors. This retrospective population-based cohort study focused on cardiovascular late effects among childhood cancer survivors in the five Nordic countries. Survivors were found to be at significantly increased risk for cardiovascular disease throughout their lives. Relative risk was highest for heart failure, valvular dysfunction, and cerebrovascular diseases. Overall, survivors had a twofold increased lifetime risk for hospitalization for cardiovascular disease.},
  author       = {Gudmundsdottir, Thorgerdur and Winther, Jeanette F. and Licht, Sofie de Fine and Bonnesen, Trine G. and Asdahl, Peter H. and Tryggvadottir, Laufey and Anderson, Harald and Wesenberg, Finn and Malila, Nea and Hasle, Henrik and Olsen, Jorgen H.},
  issn         = {0020-7136},
  keyword      = {childhood cancer,late complications,cardiovascular disease,hospitalizations,clinical epidemiology},
  language     = {eng},
  number       = {5},
  pages        = {1176--1186},
  publisher    = {John Wiley & Sons},
  series       = {International Journal of Cancer},
  title        = {Cardiovascular disease in Adult Life after Childhood Cancer in Scandinavia: A population-based cohort study of 32,308 one-year survivors},
  url          = {http://dx.doi.org/10.1002/ijc.29468},
  volume       = {137},
  year         = {2015},
}