nach oben

23.04.2024

Cardiovascular screening outcomes in the Dutch survivorship care program for Hodgkin lymphoma survivors

verfasst von: Eline M. J. Lammers, Annelies Nijdam, Josée M. Zijlstra, Cécile P. M. Janus, Roel J. de Weijer, Yolande Appelman, Olivier C. Manintveld, Arco J. Teske, Flora E. van Leeuwen, Berthe M. P. Aleman

Erschienen in: Journal of Cancer Survivorship

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Hodgkin lymphoma (HL) survivors are at increased risk of cardiovascular disease (CVD) due to former lymphoma treatment. In 2013, cardiovascular screening for 5-year HL survivors according to national guidelines was implemented in Dutch survivorship clinics. We aim to assess the following: (1) adherence to screening guidelines and (2) the yield of (risk factors for) CVD in the screening program.

Methods

The study population consisted of 5-year HL survivors who received survivorship care at three University Medical Centers from 2013 to 2016 through 2021. Patient characteristics, cardiovascular screening procedures, and outcomes were collected from the medical records.

Results

In 186 survivors eligible for cardiovascular screening (mean age 47.8 years, 60.8% female), the following diagnostics were performed: complete blood tests (81.0%, median frequency: yearly instead of advised 5-yearly evaluation), electrocardiogram (93.0%), echocardiography (94.6%). Fifty-five percent of survivors had at least one modifiable cardiovascular risk factor (i.e., current smoking, overweight, new/insufficiently controlled hypertension, dyslipidemia, or diabetes). Screening detected ≥ 1 CVD in 31.1% of survivors. Among survivors with available echocardiography report (n = 106), screening detected new aortic and/or mitral valve dysfunction(s) in 51.0% (with grades 3–4 in 4.9%) and impaired left ventricular ejection fraction in 10.3%.

Conclusions

Adherence to the screening guidelines in the Dutch HL survivorship care program was reasonable to good and a substantial number of actionable (risk factors for) CVD were diagnosed.

Implications for Cancer Survivors.

Our findings inform HL survivors at high risk of late cardiotoxicity about cardiovascular screening findings and demonstrate appropriate therapeutic actions after diagnosis of (risk factors for) CVD.

Nur mit Berechtigung zugänglich

Borchmann P, Eichenauer DA, Engert A. State of the art in the treatment of Hodgkin lymphoma. Nat Rev Clin Oncol. 2012;9(8):450–9. https://doi.org/10.1038/nrclinonc.2012.91.CrossRefPubMed

Eichenauer DA, Aleman BMP, Andre M, Federico M, Hutchings M, Illidge T, et al. Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv19–29. https://doi.org/10.1093/annonc/mdy080.

Ng AK, van Leeuwen FE. Hodgkin lymphoma: late effects of treatment and guidelines for surveillance. Semin Hematol. 2016;53(3):209–15. https://doi.org/10.1053/j.seminhematol.2016.05.008.CrossRefPubMed

de Vries S, Schaapveld M, van Nimwegen FA, Jozwiak K, Lugtenburg PJ, Daniels LA, et al. High burden of subsequent malignant neoplasms and cardiovascular disease in long-term Hodgkin lymphoma survivors. Br J Cancer. 2018;118(6):887–95. https://doi.org/10.1038/bjc.2017.476.CrossRefPubMedPubMedCentral

Aleman BM, van den Belt-Dusebout AW, De Bruin ML, van ’t Veer MB, Baaijens MH, de Boer JP, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood. 2007;109(5):1878–86. https://doi.org/10.1182/blood-2006-07-034405.CrossRefPubMed

van Nimwegen FA, Schaapveld M, Janus CP, Krol AD, Petersen EJ, Raemaekers JM, et al. Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk. JAMA Intern Med. 2015;175(6):1007–17. https://doi.org/10.1001/jamainternmed.2015.1180.CrossRefPubMed

Herrmann J, Lenihan D, Armenian S, Barac A, Blaes A, Cardinale D, et al. Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement. Eur Heart J. 2022;43(4):280–99. https://doi.org/10.1093/eurheartj/ehab674.CrossRefPubMed

Myrehaug S, Pintilie M, Tsang R, Mackenzie R, Crump M, Chen Z, et al. Cardiac morbidity following modern treatment for Hodgkin lymphoma: supra-additive cardiotoxicity of doxorubicin and radiation therapy. Leuk Lymphoma. 2008;49(8):1486–93. https://doi.org/10.1080/10428190802140873.CrossRefPubMed

Feijen EAM, Leisenring WM, Stratton KL, Ness KK, van der Pal HJH, van Dalen EC, et al. Derivation of anthracycline and anthraquinone equivalence ratios to doxorubicin for late-onset cardiotoxicity. JAMA Oncol. 2019;5(6):864–71. https://doi.org/10.1001/jamaoncol.2018.6634.CrossRefPubMedPubMedCentral

10.

Hudson MM, Rai SN, Nunez C, Merchant TE, Marina NM, Zalamea N, et al. Noninvasive evaluation of late anthracycline cardiac toxicity in childhood cancer survivors. J Clin Oncol. 2007;25(24):3635–43. https://doi.org/10.1200/JCO.2006.09.7451.CrossRefPubMed

11.

van Dalen EC, van der Pal HJ, Kok WE, Caron HN, Kremer LC. Clinical heart failure in a cohort of children treated with anthracyclines: a long-term follow-up study. Eur J Cancer. 2006;42(18):3191–8. https://doi.org/10.1016/j.ejca.2006.08.005.CrossRefPubMed

12.

McCabe MS, Faithfull S, Makin W, Wengstrom Y. Survivorship programs and care planning. Cancer. 2013;119(Suppl 11):2179–86. https://doi.org/10.1002/cncr.28068.CrossRefPubMed

13.

Barbui T, Bjorkholm M, Gratwohl A. Cancer survivorship programs: time for concerted action. Haematologica. 2014;99(8):1273–6. https://doi.org/10.3324/haematol.2014.104059.CrossRefPubMedPubMedCentral

14.

Nijdam A, Dekker N, Aleman BMP, van ‘t Veer MB, Daniels LA, van der Maazen RW, et al. Setting up a national infrastructure for survivorship care after treatment for Hodgkin lymphoma. Br J Haematol. 2019;186(4):103–8. https://doi.org/10.1111/bjh.15936.CrossRef

15.

Dutch society for Radiation Therapy and Oncology (NVRO). Cardiovascular adverse effects after Hodgkin lymphoma. 2016. https://richtlijnendatabase.nl/richtlijn/cardiovasculaire_schade_na_hodgkinlymfoom/cardiovasculaire_hodgkinlymfoom_-_startpagina.html#:~:text=Zo%20kan%20bestraling%20en%20chemotherapie,ontwikkelen%20van%20hart%2D%20en%20vaatziekten. Accessed 3 July 2023.

16.

Armstrong GT, Joshi VM, Ness KK, Marwick TH, Zhang N, Srivastava D, et al. Comprehensive echocardiographic detection of treatment-related cardiac dysfunction in adult survivors of childhood cancer: results from the St. Jude lifetime cohort study. J Am Coll Cardiol. 2015;65(23):2511–22. https://doi.org/10.1016/j.jacc.2015.04.013.CrossRefPubMedPubMedCentral

17.

Palmer C, Mazur W, Truong V, Nagueh S, Fowler J, Shelton K, et al. Prevalence of diastolic dysfunction in adult survivors of childhood cancer. J Am Coll Cardiol CardioOnc. 2023;5(3):377–88. https://doi.org/10.1016/j.jaccao.2022.12.010.CrossRef

18.

American College of Cardiology. Left ventricular ejection fraction LVEF assessment (outpatient setting). https://www.acc.org/tools-and-practice-support/clinical-toolkits/~/media/1E4D8F9B69D14F55821BFE642FBFA221.ashx. Accessed 3 July 2023.

19.

Chow EJ, Chen Y, Armstrong GT, Baldwin LM, Cai CR, Gibson TM, et al. Underdiagnosis and undertreatment of modifiable cardiovascular risk factors among survivors of childhood cancer. J Am Heart Assoc. 2022;11(12):e024735. https://doi.org/10.1161/JAHA.121.024735.CrossRefPubMedPubMedCentral

20.

Tijn-A-Ton JJS, Konings KTS. Dutch college of general practioners (NHG) guideline cardiovascular risk management version 4.0. https://richtlijnen.nhg.org/standaarden/cardiovasculair-risicomanagement. Accessed 3 July 2023.

21.

Janssen PG, Gorter KJ, Stolk RP, Rutten GE. Low yield of population-based screening for Type 2 diabetes in the Netherlands: the ADDITION Netherlands study. Fam Pract. 2007;24(6):555–61. https://doi.org/10.1093/fampra/cmm052.CrossRefPubMed

22.

Heidenreich PA, Hancock SL, Lee BK, Mariscal CS, Schnittger I. Asymptomatic cardiac disease following mediastinal irradiation. J Am Coll Cardiol. 2003;42(4):743–9. https://doi.org/10.1016/s0735-1097(03)00759-9.CrossRefPubMed

23.

Wethal T, Lund MB, Edvardsen T, Fossa SD, Pripp AH, Holte H, et al. Valvular dysfunction and left ventricular changes in Hodgkin’s lymphoma survivors. A longitudinal study Br J Cancer. 2009;101(4):575–81. https://doi.org/10.1038/sj.bjc.6605191.CrossRefPubMed

24.

Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72–227. https://doi.org/10.1161/CIR.0000000000000923.CrossRefPubMed

25.

Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):1757–80. https://doi.org/10.1016/j.jacc.2021.12.011.CrossRefPubMed

26.

Wang TJ, Evans JC, Benjamin EJ, Levy D, LeRoy EC, Vasan RS. Natural history of asymptomatic left ventricular systolic dysfunction in the community. Circulation. 2003;108(8):977–82. https://doi.org/10.1161/01.CIR.0000085166.44904.79.CrossRefPubMed

27.

Mulrooney DA, Armstrong GT, Huang S, Ness KK, Ehrhardt MJ, Joshi VM, et al. Cardiac outcomes in adult survivors of childhood cancer exposed to cardiotoxic therapy: a cross-sectional study. Ann Intern Med. 2016;164(2):93–101. https://doi.org/10.7326/M15-0424.CrossRefPubMedPubMedCentral

28.

Lyon AR, Lopez-Fernandez T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, et al. ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging. 2022. https://doi.org/10.1093/ehjci/jeac106.CrossRefPubMed

29.

Wu S, Chai A, Arimie S, Mehra A, Clavijo L, Matthews RV, et al. Incidence and treatment of severe primary mitral regurgitation in contemporary clinical practice. Cardiovasc Revasc Med. 2018;19(8):960–3. https://doi.org/10.1016/j.carrev.2018.07.021.CrossRefPubMed

30.

Murbraech K, Wethal T, Smeland KB, Holte H, Loge JH, Holte E, et al. Valvular dysfunction in lymphoma survivors treated with autologous stem cell transplantation: a national cross-sectional study. JACC Cardiovasc Imaging. 2016;9(3):230–9. https://doi.org/10.1016/j.jcmg.2015.06.028.CrossRefPubMed

31.

Mulrooney DA, Hyun G, Ness KK, Ehrhardt MJ, Yasui Y, Duprez D, et al. Major cardiac events for adult survivors of childhood cancer diagnosed between 1970 and 1999: report from the Childhood Cancer Survivor Study cohort. BMJ. 2020;368:l6794. https://doi.org/10.1136/bmj.l6794.CrossRefPubMedPubMedCentral

32.

Bergom C, Bradley JA, Ng AK, Samson P, Robinson C, Lopez-Mattei J, et al. Past, present, and future of radiation-induced cardiotoxicity: refinements in targeting, surveillance, and risk stratification. JACC CardioOncol. 2021;3(3):343–59. https://doi.org/10.1016/j.jaccao.2021.06.007.CrossRefPubMedPubMedCentral

Titel: Cardiovascular screening outcomes in the Dutch survivorship care program for Hodgkin lymphoma survivors
verfasst von: Eline M. J. Lammers
Annelies Nijdam
Josée M. Zijlstra
Cécile P. M. Janus
Roel J. de Weijer
Yolande Appelman
Olivier C. Manintveld
Arco J. Teske
Flora E. van Leeuwen
Berthe M. P. Aleman
Publikationsdatum: 23.04.2024
Verlag: Springer US
Erschienen in: Journal of Cancer Survivorship
Print ISSN: 1932-2259
Elektronische ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-024-01561-y

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Cardiovascular screening outcomes in the Dutch survivorship care program for Hodgkin lymphoma survivors

Abstract

Purpose

Methods

Results

Conclusions

Implications for Cancer Survivors.

Neu im Fachgebiet Onkologie

Alphablocker schützt vor Miktionsproblemen nach der Biopsie

Antikörper-Wirkstoff-Konjugat hält solide Tumoren in Schach

Mammakarzinom: Senken Statine das krebsbedingte Sterberisiko?

Labor, CT-Anthropometrie zeigen Risiko für Pankreaskrebs

Update Onkologie

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Implications for Cancer Survivors.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Neu im Fachgebiet Onkologie

Alphablocker schützt vor Miktionsproblemen nach der Biopsie

Antikörper-Wirkstoff-Konjugat hält solide Tumoren in Schach

Mammakarzinom: Senken Statine das krebsbedingte Sterberisiko?

Labor, CT-Anthropometrie zeigen Risiko für Pankreaskrebs

Update Onkologie