Scoring to Predict Individual Risk of Heart Failure Among Childhood Cancer Survivors
In a study reported in the Journal of Clinical Oncology, Chow and colleagues developed risk scoring that can identify likelihood of heart failure among childhood cancer survivors.
Study Details
The study involved survivors in the Childhood Cancer Survivor Study (CCSS) free of significant cardiovascular disease 5 years after cancer diagnosis (n = 13,060) who were observed through age 40 years for the development of heart failure requiring medication or heart transplantation or leading to death (n = 285). Baseline risk was identified in a sibling population (n = 4,023). Validation cohorts consisted of 3,421 survivors from Emma Children’s Hospital in Amsterdam, the National Wilms Tumor Study, and the St. Jude Lifetime Cohort Study (heart failure in total of 93).
Risk Scoring
A standard model in which clinical dose information was known was developed, with points assigned for risk exposures as follows: female sex = 1; age at diagnosis of < 5 years = 2, 5 to 9 years = 1; anthracycline exposure < 100, 100 to 249, and ≥ 250 mg/m2 = 1, 3, and 4; and chest or heart radiation therapy at 5 to 14, 15 to 34, and ≥ 35 Gy = 2, 2, and 4.
Risk scoring on the standard model achieved an area under the curve (AUC) of 0.74 and concordance statistic of 0.76 at or through age 40 years. In the three validation populations, the standard model provided AUC estimates of 0.68 to 0.81 and concordance statistic values of 0.68 to 0.82.
Risk Levels
Total risk scores on this model of < 3, 3 to 5, and ≥6 formed statistically distinct low-, moderate-, and high-risk groups with cumulative incidences of heart failure at age 40 years of 0.5% (95% confidence interval [CI] = 0.2%–0.8%), 2.4% (95% CI = 1.8%–3.0%), and 11.7% (95% CI = 8.8%–14.5%). Siblings of the CCSS cohort had a cumulative incidence of 0.3% (95% CI = 0.1%–0.5%).
The investigators concluded: “Using information available to clinicians soon after completion of childhood cancer therapy, individual risk for subsequent heart failure can be predicted with reasonable accuracy and discrimination. These validated models provide a framework on which to base future screening strategies and interventions.”
Eric J. Chow, MD, MPH, of Fred Hutchinson Cancer Research Center, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by grants from the National Institutes of Health and PanCareSurFup EU and by the American Lebanese Syrian Associated Charities, Leukemia and Lymphoma Society, and Tom Voûte Fund. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
