Subclinical late cardiac toxicity in childhood cancer survivors: impact on self-reported health.
BACKGROUND
The authors analyzed how self-reported health and self-reported modified New York Heart Association (NYHA) cardiac function scores were related to cardiac systolic function, cardiac risk factors, and cancer treatment history in childhood cancer survivors who reported no symptoms of cardiac disease.


METHODS
Long-term survivors of pediatric cancer who were treated between 1971 and 1995 (current ages, 16-39.7 years) underwent noninvasive clinical and laboratory cardiac risk evaluation and responded to selected subscales of the Medical Outcomes Study 36-item Short Form Health Survey. Results were compared with survivor history of anthracycline therapy alone or with radiotherapy (n=127 patients; mean, 10 years after diagnosis) versus no anthracycline therapy (n=32 patients; mean, 11 years after diagnosis).


RESULTS
Sex, current age, highest school grade completed, race, age at diagnosis, diagnostic group, years off therapy, fractional shortening (FS), heart rate, and smoking status were found to be independently predictive of self-reported health. Interaction between female sex and higher low-density lipoprotein values and between diagnosis and abnormal FS variably predicted low reported vitality and low reported modified New York Heart Association (NYHA) scores. Echocardiographic findings, cardiac risk factors, and treatment history explained 13% to 28% of the variance in perceived health and self-reported modified NYHA scores.


CONCLUSIONS
Systolic function and cardiac risk factors were linked to lower self-reported health and NYHA scores even in the absence of clinically evident cardiotoxicity.
Cox
Cheryl L
CL
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. cheryl.cox@stjude.org
Rai
Shesh N
SN
Rosenthal
David
D
Phipps
Sean
S
Hudson
Melissa M
MM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018943:Anthracyclines / Q000009:adverse effects; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001294:Attitude to Health; D008078:Cholesterol, LDL / Q000097:blood; D004452:Echocardiography; D004522:Educational Status; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000528:radiation effects; D006339:Heart Rate / Q000187:drug effects / Q000528:radiation effects; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D044469:Racial Groups; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D018570:Risk Assessment; D012737:Sex Factors; D012907:Smoking; D017741:Survivors; D013599:Systole / Q000187:drug effects / Q000528:radiation effects; D016896:Treatment Outcome
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D008078:Cholesterol, LDL