Cardiotoxicity caused by chemotherapy

Cardiotoxicity is a well-recognized late effect of therapy for childhood and adolescent malignancies and is a serious problem for long-term survivors. Cardiotoxicity may be caused by chemotherapy, radiation therapy or the combined use of both modalities. A survey of pediatric cardiology centers in North America found that more than 12 per cent of all patients with cardiomyopathy had been treated for cancer during childhood or adolescence.1 In a large cohort of American patients who had survived at least 5 years from a diagnosis of pediatric cancer, the standardized mortality ratio (SMR) for overall mortality was 10.8, and the SMR for cardiac mortality was 8.2.2 A study from the Nordic countries produced similar findings (overall mortality SMR, 10.8; cardiac and circulatory system death SMR, 5.8).3 The SMR for sudden or illdefined deaths was 3.9; some of these deaths were probably attributable to cardiac causes.3.