期刊
INTERNATIONAL JOURNAL OF CANCER
卷 148, 期 3, 页码 572-583出版社
WILEY
DOI: 10.1002/ijc.33218
关键词
cancer survivorship; cohort; epidemiology; late effects
类别
资金
- Academy of Medical Sciences
- Cancer Research UK [C386/A10422, C8225/A21133]
- Children with Cancer UK [20457]
- MRC [MC_U137686858] Funding Source: UKRI
Childhood cancer survivors treated with cranial irradiation are at increased risk of cerebrovascular disease, with survivors of central nervous system tumors and leukemia at the greatest risk. The risk of CVD continues to rise substantially beyond age 50, highlighting the need for ongoing monitoring and lifestyle interventions in this population.
Survivors of childhood cancer treated with cranial irradiation are at risk of cerebrovascular disease (CVD), but the risks beyond age 50 are unknown. In all, 13457 survivors of childhood cancer included in the population-based British Childhood Cancer Survivor Study cohort were linked to Hospital Episode Statistics data for England. Risk of CVD related hospitalisation was quantified by standardised hospitalisation ratios (SHRs), absolute excess risks and cumulative incidence. Overall, 315 (2.3%) survivors had been hospitalised at least once for CVD with a 4-fold risk compared to that expected (95% confidence interval [CI]: 3.7-4.3). Survivors of a central nervous system (CNS) tumour and leukaemia treated with cranial irradiation were at greatest risk of CVD (SHR = 15.6, 95% CI: 14.0-17.4; SHR = 5.4; 95% CI: 4.5-6.5, respectively). Beyond age 60, on average, 3.1% of CNS tumour survivors treated with cranial irradiation were hospitalised annually for CVD (0.4% general population). Cumulative incidence of CVD increased from 16.0% at age 50 to 26.0% at age 65 (general population: 1.4-4.2%). In conclusion, among CNS tumour survivors treated with cranial irradiation, the risk of CVD continues to increase substantially beyond age 50 up to at least age 65. Such survivors should be: counselled regarding this risk; regularly monitored for hypertension, dyslipidaemia and diabetes; advised on life-style risk behaviours. Future research should include the recall for counselling and brain MRI to identify subgroups that could benefit from pharmacological or surgical intervention and establishment of a case-control study to comprehensively determine risk-factors for CVD.
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