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The Oncologist, the Patient and CKN — Sharing Knowledge

Chemotherapy Exposure and EKG Changes: What Do They Mean?

GregoryAuneby Gregory Aune, MD, PhD, CKN Editor

 

Childhood Cancer Survivors have their own unique set of issues that often go unaddressed by health care professionals once treatment has ended and the child enters adulthood.  Although the last 20 years have seen growth in survivorship research, this research is rarely filtered down to the people who need it most – the survivors and their families.  Dr. Gregory Aune, Pediatric Oncologist, researcher, childhood cancer survivor and advocate, has taken on the position of CKN Editor, Knowledge Translation – Childhood Cancer Survivorship.  His goal is simple:  to help empower childhood cancer survivors to start a dialogue with their doctors by publishing short, easy-to-read research study summaries, like this one.

 


THE HEADLINE:  Electrocardiography’s role in screening for cardiotoxicity in adult survivors of childhood cancer survivors treated with anthracyclines: Time for a true prospective study?

RESEARCH: Pediatric Blood and Cancer: Electrophysiological effects of anthracyclines in adult survivors of pediatric malignancy. Researchers at Johns Hopkins Hospital conducted a retrospective chart review of 147 survivors of childhood cancer that were now over the age of 18. The goal of the study was to evaluate the correlation between abnormalities in electrocardiographic changes and cardiac dysfunction noted by echocardiographic measurements. Survivors were selected that had at least one EKG and one echocardiogram. Statistical comparisons were then made between EKG findings, echocardiographic data, and treatment data.

KEY FINDINGS: 24% of patients had left ventricular dysfunction and the initial QTc interval (measurement from EKG tracing) was elongated in patients with dysfunction. In patients where EKG’s were performed prior to the onset of left ventricular dysfunction, the QTc was prolonged. In contrast, when no left ventricular dysfunction was noted by echocardiography measurements prior EKG’s showed no prolongation of the QTc. Primary conclusion: In this small sample of adult survivors of childhood cancer, prolonged QTc interval measured by EKG was associated subsequent development of left ventricular dysfunction.

WHAT THIS MEANS FOR CHILDHOOD CANCER SURVIVORS: This week’s post is the first in a series that will explore the cardiovascular complications associated with childhood exposure to chemotherapy and radiation. This interesting study investigates the utility of using changes in EKG tracings as a predictor of future development of decreased pumping capacity of the heart. It is estimated that up to 20% of survivors with a history of exposure to a class of chemotherapy agents commonly used called anthracyclines, will develop decreased functional capacity in the heart. This condition is widely considered to be irreversible and can lead to heart failure. Therefore, it is essential that all survivors with this exposure are aware of this possible outcome and receive periodic heart evaluations including an EKG and echocardiogram. In the case where survivors are under the care of providers not familiar with established screening guidelines for survivors, they are encouraged to speak up about their individual cardiovascular risks that stem from prior exposures. Severe cardiovascular complications can go missed in survivors because of their occurrence at younger ages than typically expected and atypical symptomatology.

 


 

Medical Disclaimer:  The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only.  If you feel the research summarized applies to you or someone you know, talk to your doctor about your concerns.

 


 

Videos with Dr. Aune

Presentation on YouTube (Jan 2015):  Eliminating Long-term Health Effects in Cancer Survivors – Gregory Aune, MD, PhD

Interview for the National Coalition for Cancer Survivorship (June 2015):  Hodgkin’s Lymphoma Survivor Dr. Greg Aune Discusses Issues in Long-Term Survivorship Care

Interview with the Washington Post Live Summit (Dec 2016): How cancer lives on in young adults after treatment ends

 


 

Dr. Gregory J. Aune is the Stephanie Edlund Distinguished Professor of Pediatric Cancer Research and a St. Baldrick’s Foundation Scholar.  His experience in pediatric cancer spans over 27 years and encompasses his own patient experiences, research in experimental therapeutics, clinical care of pediatric oncology patients, and childhood cancer advocacy.  His interest in pediatric oncology began at age 16, when he was diagnosed with Hodgkin’s lymphoma.  While fortunate to survive, the experiences he encountered as a patient initiated a path towards a research and clinical career aimed at developing less toxic chemotherapy regimens.  His experience as a long-term survivor included open-heart surgery at age 35 to replace his aortic valve and bypass three blocked coronary arteries that were damaged by his teenage cancer therapies.  This life-changing event initiated his research interest in cardiac disease.  His training to become a successful physician scientist and pediatric oncologist has included time spent at some of the most well-respected oncology institutions in the United States including, M.D. Anderson Cancer Center, the National Cancer Institute, and Johns Hopkins Hospital.

Dr. Aune is a national leader in childhood cancer advocacy efforts.  In San Antonio, he has been a leader in local fundraising and awareness efforts.   Since 2010, he has spearheaded efforts by the St. Baldrick’s Foundation and For the Kids Dance Marathon at the University of Texas San Antonio that have raised over $830,000 for childhood cancer patients and research efforts.  In September 2014, his appointment to the National Cancer Institute Council of Research Advocates (NCRA) was announced by NCI Director Dr. Harold Varmus at a White House briefing on childhood cancer.

In addition, Dr. Aune is a policy advisor for the National Coalition for Cancer Survivorship, serves on the Board of Directors of the American Childhood Cancer Organization, is a member of the St. Baldrick’s Foundation National Advocacy Committee, and serves on the scientific advisory board for the Canines-N-Kids foundation.

In May 2015, Dr. Aune addressed the 68th World Health Assembly in Geneva, Switzerland and called on the World Health Organization to make childhood cancer a top global health priority.

 


 

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