Lifestyle Behaviors and Cardiotoxic Treatment Risks in Adult Childhood Cancer Survivors

Higher doses of anthracyclines and heart-relevant radiotherapy increase cardiovascular disease (CVD) risk. This study assessed CVD and CVD risk factors among adult childhood cancer survivors (CCSs) across cardiotoxic treatment risk groups and examined associations between lifestyle behaviors and treatment risks.

We invited CCSs aged ≥18 years at study, diagnosed at ages 0-20, who survived ≥5 years for an assessment of anthropometry, CVD, CVD risk factors, lifestyle, and cancer history. We classified participants into three cardiotoxic treatment risk groups (no/low risk, moderate risk, high risk) based on anthracyclines and heart-relevant radiotherapy. Multinomial logistic regression assessed lifestyle differences across groups.

With a median age at study of 33 years (IQR: 26-39; 53% male), 356 CCSs participated in this study divided into the no/low risk (25%), moderate risk (40%), or high risk (35%) cardiotoxic treatment groups. Overall, CVD prevalence was 6% and similar across the three risk groups. Heart valve problems were rare, though more common in the high-risk group (no/low risk, 0%; moderate risk, 1%; vs. high risk, 4%; p = 0.037). CVD risk factors were present in 44% of CCSs-including dyslipidemia, obesity, hypertension, and diabetes-without variation across risk groups. Overall adherence to health behavior recommendations was low, with no differences in diet adherence, physical activity (PA), sedentary behavior, smoking, or alcohol consumption across cardiotoxic risk groups.

We found no differences in CVD, CVD risk factors, or lifestyle behaviors across cardiotoxic treatment risk groups. Health promotion that engages diet, PA, smoking cessation, and alcohol reduction should be prioritized for all CCSs regardless of cardiotoxic treatment risk levels.