European Journal of Cancer: Coronary artery disease surveillance among childhood, adolescent and young adult cancer survivors: A systematic review and recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group (Aune)

Highlights

Cancer survivors are at risk for premature coronary artery disease (CAD).
Especially survivors treated with radiotherapy exposing the heart.
This guideline provides recommendations for CAD surveillance.
Early monitoring and management of modifiable risk factors is recommended.
Key knowledge gaps regarding CAD in cancer survivors require further investigation.

Abstract

Background

Coronary artery disease (CAD) is a concerning late outcome for cancer survivors. However, uniform surveillance guidelines are lacking.

Aim

To harmonize international recommendations for CAD surveillance for survivors of childhood, adolescent, and young adult (CAYA) cancers.

Methods

A systematic literature review was performed and evidence graded using the Grading of Recommendations, Assessment, Development, and Evaluation criteria. Eligibility included English language studies, a minimum of 20 off-therapy cancer survivors assessed for CAD, and 75% diagnosed prior to age 35 years. All study designs were included, and a multidisciplinary guideline panel formulated and graded recommendations.

Results

32 of 522 identified articles met eligibility criteria. The prevalence of CAD ranged from 0 to 72% and was significantly increased compared to control populations. The risk of CAD was increased among survivors who received radiotherapy exposing the heart, especially at doses ≥15 Gy (moderate-quality evidence). The guideline panel agreed that healthcare providers and CAYA cancer survivors treated with radiotherapy exposing the heart should be counselled about the increased risk for premature CAD. While the evidence is insufficient to support primary screening, monitoring and early management of modifiable cardiovascular risk factors are recommended. Initiation and frequency of surveillance should be based on the intensity of treatment exposures, family history, and presence of co-morbidities but at least by age 40 years and at a minimum of every 5 years. All were strong recommendations.

Conclusion

These systematically assessed and harmonized recommendations for CAD surveillance will inform care and guide research concerning this critical outcome for CAYA cancer survivors.

Keywords

Coronary artery disease
Childhood, adolescent and young adult cancer survivors
Clinical practice guideline

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Since 2004, UT Health San Antonio, Greehey Children’s Cancer Research Institute’s (Greehey CCRI) mission has been to advance scientific knowledge relevant to childhood cancer, contribute to the understanding of its causes, and accelerate the translation of knowledge into novel therapies. Through discovery, development, and dissemination of new scientific knowledge, Greehey CCRI strives to have a national and global impact on childhood cancer. Our mission consists of three key areas — research, clinical, and education.

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Article Categories: Research Paper