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Most children’s cancer survivors do not develop heart problems; however, certain types of cancer treatment can result in problems with the heart. Since heart problems may occur many years after cancer treatment, it is important for children’s cancer survivors to be aware of any treatments they received that can affect the heart. That way, they can take steps to keep their heart healthy, including regular medical check-ups and tests to monitor heart function. And if a problem develops, it can be detected and treated early.
The heart can be affected by certain types of chemotherapy and by radiation therapy.
Radiation therapy may result in scarring and stiffening of heart tissues, causing abnormal heart rhythm (arrhythmia) and problems with the heart muscle (cardiomyopathy), heart valves (valvular stenosis or insufficiency), blood vessels (coronary artery disease), and membrane surrounding the heart (pericarditis or pericardial fibrosis).
Most children’s cancer survivors who were treated with anthracyclines or chest radiation have no heart damage at all. Some survivors have very mild changes in heart size or function that have not gotten worse over time. Only a small number of survivors have developed severe heart problems leading to heart failure or dangerous heart rhythms. Overall, the risk of developing heart problems after children’s cancer therapy is highest in survivors treated with higher doses of anthracyclines or chest radiation, especially those who received both treatments at a young age.
A heart affected by anthracyclines and chest radiation may not be able to handle the stress of certain conditions that dramatically increase heart rate, blood pressure, or volume of blood in the circulatory system.
If cancer treatment included medicines that can affect heart function, patients need to work with their doctor in order to ensure reduced stress to the heart. Some drugs may cause stress to the circulatory system, including cocaine, diet pills, ephedra, mahuang, and performance-enhancing drugs. These types of drugs have been associated with worsening of heart function and even death in children’s cancer survivors who received anthracycline chemotherapy.
Anyone treated with anthracycline chemotherapy or chest radiation for children’s cancer should have a yearly check-up that should include specific evaluation of any symptoms relating to the heart. In addition, an electrocardiogram (ECG, EKG) should be done at the time the survivor enters long-term follow-up (usually about 5 years from diagnosis or 2 years from completion of therapy). An echocardiogram or Multi- Gated Acquisition (MUGA) scan is also recommended at the first long-term follow-up visit, then according to the following schedule (or as recommended by the healthcare provider):
Schedule for Echocardiogram or MUGA Scans
Total anthracycline dose**
Recommended frequency of ECHO or MUGA
< 1 year
< 200 mg/m²
Every 2 years
≥ 200 mg/m²
1 to 4 years old
< 100 mg/m²
Every 5 years
≥ 100 to < 300 mg/m²
≥ 300 mg/m²
≥ 5 years old
< 300 mg/m²
≥ 200 to <300><300 mg/m²="mg/m²" </td="</td" />300
*Age at first treatment with anthracycline or chest radiation (whichever was given first). **Based on total doses if doxorubicin/daunorubicin or the equivalent doses of other anthracyclines.
Survivors who received radiation at a dose of 40 Gy (4000 cGy) or higher to the heart or surrounding tissues or radiation at a dose of 30 Gy (3000 cGy) or higher plus anthracycline chemotherapy should do a stress test 5 to 10 years following radiation, then as recommended by a cardiologist.
Survivors who received radiation to the heart or surrounding tissues should also have a blood test to check for other cardiac risk factors (lipid profile and fasting glucose) every 3 to 5 years.
Common Heart TestsAn electrocardiogram (EKG) is used to evaluate heart rate and rhythm. Electrodes (small sticky patches that conduct electricity) are placed on the chest, arms, and legs. Wires are attached to the electrodes and the electrical impulses of the heart are recorded.
An echocardiogram (heart ultrasound) is used to test the muscle function of the heart and determine how well it pumps. The patient lies on a table and a technician applies conductive jelly to the chest. Then, a transducer (handheld device that emits the ultrasound waves) is placed on the chest to obtain different views of the heart. The echocardiogram technician will apply slight pressure on the transducer, to the chest. The test results are recorded for the doctor to review. Many measurements are done during this test to help find out if the heart muscle is pumping blood well. The ultrasound test also looks at the valves of the heart to check that they open and close normally. Electrodes are usually placed on the chest to monitor the heart’s electrical impulses during the test.
If someone has diabetes, high blood pressure, or high blood cholesterol, they should try to keep these under good control with diet or medication as recommended by their healthcare provider. Any symptoms of heart problems should be promptly reported to a healthcare provider.