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Cardiovascular disease in adult survivors of childhood cancer

January 04, 2016

1. Asymptomatic cardiovascular disease is prevalent and occurs earlier in adult survivors of childhood cancer

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-0424

URL live when embargo lifts

For adult survivors of childhood cancer, cardiovascular disease presents at an earlier age, is associated with substantial morbidity, and is often asymptomatic. According to researchers, the type and frequency of screening that should be used in this group is not clear. The study is published in Annals of Internal Medicine.

The number of adult survivors of childhood or adolescent cancer is projected to surpass 500,000 by 2020. Historically, the leading cause of death has been cancer recurrence. However, late effects of therapy have become the leading cause of death 30 years after diagnosis, and deaths are frequently attributed to premature cardiovascular disease. Utilizing data from the St. Jude Lifetime Cohort Study, researchers systematically assessed cardiac outcomes among survivors of childhood cancer. The data showed evidence of cardiomyopathies, conduction or rhythm abnormalities and coronary artery and valvular diseases in substantial numbers of adult survivors of childhood cancer who were exposed to cardiotoxic therapies. Many of the patients were younger and asymptomatic, suggesting that prospective studies to assess the potential value of screening for cardiac abnormalities in adult survivors of childhood cancer are needed.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Dr. David Himmelstein, please call him directly on his cell at 617-312-0970.

2. Public health experts say some patients may benefit from routine physical exams

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2097

URL live when embargo lifts

The authors of an article published in Annals of Internal Medicine say that arguments against routine physical exams are based on insufficient evidence from an outdated review. They suggest that some patients, especially those in vulnerable or high risk groups, could benefit from routine visits.

The authors support their position with newer evidence from a systematic review published in Annals of Internal Medicine that examined 33 studies of periodic health evaluations that consisted 'only of the history, risk assessment, and a tailored physical examination.' The evidence showed that the periodic health exam improved delivery of some recommended preventive services and may lessen patient worry. In their personal experience, such visits have led to new diagnoses of melanoma, colon and breast cancer, alcohol abuse, opiate addiction, and depression -- diagnoses that would otherwise have been delayed or missed. The authors suggest that this evidence justifies implementation of the periodic health exam in clinical practice.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, please contact Debbie Raskin at draskin@rubenstein.com or 212-843-8028.
-end-
Also in this issue:

Interrupting Ebola Transmission in Liberia Through Community-Based Initiatives

Mosoka Fallah, PhD, MPH; Bernice Dahn, MD, MPH; Tolbert G. Nyenswah, Esq, MPH; Moses Massaquoi, MD, MPH; Laura A. Skrip, MPH; Dan Yamin, PhD; Martial Ndeffo Mbah, PhD; Netty Joe, MD; Siedoh Freeman, MD; Thomas Harris, BA; Zinnah Benson, BBA; and Alison P. Galvani, PhD

Ideas and Opinions

http://www.annals.org/article.aspx?doi=10.7326/M15-1464

American College of Physicians

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