Abstract 4370372: Cardiovascular outcomes for childhood cancer survivors in a diverse patient population

Abstract

Background: Advances in pediatric oncology have led to a growing population of childhood cancer survivors (CCS), who are at increased risk for cardiovascular disease (CVD). Most existing data, however, come from predominantly non-Hispanic White cohorts, limiting our understanding of outcomes in diverse populations. Hypothesis: Non-Hispanic Black and Hispanic CCS have worse cardiovascular outcomes, including lower ejection fraction (EF) and higher rates of heart failure (HF), compared to non-Hispanic White CCS. Methods: We conducted a retrospective cohort study of 337 CCS treated at a single academic institution. Demographic (age, sex, race/ethnicity), cancer-related (type, treatment with anthracyclines and/or radiation), and cardiac function (left ventricular ejection fraction [LVEF] or fractional shortening) were collected at baseline, post-treatment, and ≥1-year follow-up. Results: A diverse retrospective cohort of 337 childhood cancer survivors was analyzed (48% female, 11% non-Hispanic White, 21% non-Hispanic Black, 54% Hispanic). There were 143 patients with leukemia, 67 patients with lymphoma and 53 patients with sarcoma. The rest survivors (n=74) had either central nervous system tumor, germ cell tumor, neuroblastoma, or renal tumor. Age of diagnosis was 9.4±6.8 years. Among them, 76% of survivors received anthracycline-based chemotherapy with mean cumulative dose of 210.5±127mg/m 2 . Baseline cardiac function was normal in all the patients (LVEF≥50% or fractional shortening>25%) and it was similar between different racial and ethnic groups. Eleven patients (3.3%) developed clinical HF during a median follow-up time of 13 years (interquartile range 9-18 years), 4 of whom had leukemia, 3 had lymphoma, 2 had sarcoma, and 2 had other cancer types. Seven of the HF cases were non-Hispanic Black and three were Hispanic CCS. The incidence of HF in childhood cancer survivors were significantly higher in non-Hispanic Black (10%) compared to another race and ethnicity (0-2%, p=0.014). Conclusions: Non-Hispanic Black childhood cancer survivors had significantly higher rates of heart failure despite similar baseline cardiac function.