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Heart failure following blood cancer therapy in pediatric and adult populations
Author(s) -
Franzon Julie,
Berry Narelle M.,
Ullah Shahid,
Versace Vincent L.,
McCarthy Alexandra L.,
Atherton John,
Roder David,
Koczwara Bogda,
Coghlan Douglas,
Clark Robyn A.
Publication year - 2018
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.12782
Subject(s) - medicine , heart failure , cardiotoxicity , cancer registry , cancer , chemotherapy , population , proportional hazards model , pediatrics , environmental health
Aim The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalized for heart failure. Methods Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996–2009). Of all identified blood cancer patients ( N = 23 434), 8339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7522 adults. Time‐varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. Results Of those who were subsequently hospitalized for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non‐heart failure counterparts, a difference which was much greater than that between the adult groups. Conclusion The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population.