The cardiovascular impact of
cancer therapies on the heart is one of the major concerns in the long-term follow-up of childhood cancer survivors (CCSs). Long-term cardiovascular effects include the development of
left ventricular dysfunction resulting in
congestive heart failure and
ischemic heart disease, as well as valvular and pericardial disease. This is mainly ascribed to the cardiotoxic side effects of chemotherapeutic agents (especially
anthracyclines) and
radiotherapy, but other factors such as radiation and
inflammation play a role in the effect of childhood
cancer on the cardiovascular health. The most concerning effect is the high incidence of symptomatic
heart failure in CCS patients treated with
anthracyclines. More than 50 % of CCSs treated with
anthracyclines develop asymptomatic
left ventricular dysfunction after
cancer therapy, with approximately 5 % developing clinical signs of
heart failure during long-term follow-up. Once CCS patients develop
congestive heart failure, prognosis is poor and is not influenced by current medical treatment strategies. To reduce the long-term burden of
cardiovascular disease in pediatric
cancer patients, a diversified approach will be necessary. In the acute phase, prevention of cardiac damage through the use of
cardioprotective agents (e.g.,
dexrazoxane) or by administering less cardiotoxic chemotherapeutic agents is to be considered. A recent randomized trial suggested that the use of
dexrazoxane reduced
cardiac toxicity without affecting
cancer outcomes. Especially patients requiring high doses of chemotherapeutic agents could benefit from this approach. Recent data suggest that genetic testing might identify patients at higher risk for
cardiotoxicity. This seems mainly related to genes involved in
drug metabolism. This would allow personalized approach adjusting
chemotherapy based on cardiovascular risk profiling. This could be combined with newer monitoring strategies in the acute phase using newer echocardiographic techniques and
biomarker screening to identify patients with early damage to the myocardium. For the long-term CCS cohort, early detection and treatment of early dysfunction prior to the development of
congestive heart failure could potentially improve long-term outcomes. Promoting healthy lifestyles and controlling additional cardiovascular risk factors (e.g.,
obesity, diabetes, arterial
hypertension) is an important task for every physician involved in the care of this growing cohort.