TO PUT THAT INTO CONTEXT
Smita Bhatia, MD, MPH
Institute for Cancer Outcomes and Survivorship
University of Alabama at Birmingham, Birmingham, AlabamaWhat Have Been the Key Issues in This Area?
Obesity, insulin resistance/diabetes mellitus, hypertension, and dyslipidemia are a well-described set of long-term complications in childhood cancer survivors, and increase the risk for subsequent development of cardiovascular disease. Cranial radiation at a young age in girls increases risk of obesity, and total body and abdominal irradiation increase the risk of insulin resistance and dyslipidemia. Sarcopenia may aggravate the situation, as do poor diet and physical inactivity. The role of gut microbiota is currently under investigation. The few intervention studies that have been completed to date have shown a modest impact on obesity and cardiometabolic profile. This review does a great job in synthesizing the evidence to provide a balanced overview of the problem related to the cardiometabolic pathology faced by childhood cancer survivors, the extant literature on the pathogenesis, and the current evidence regarding the efficacy of the intervention strategies.What Issues Still Need to Be Addressed?
Increasing awareness regarding the magnitude of this problem, highlighting the vulnerable populations, and describing the current literature on the interventions that have demonstrated efficacy are needed-such that the clinicians can recognize this issue and address it appropriately when seeing the childhood cancer survivor in their practice. The issues that have yet to be clarified include the predilection for the development of obesity among girls exposed to cranial radiation at a young age; as well as the molecular pathogenesis of cardiometabolic perturbations, especially as the molecular underpinnings interact with therapeutic exposures and lifestyle behaviors. It is important to understand when to intervene and how to intervene, so that the interventions are effective. Finally, it is important to see how the changes in therapy will modify this cardiometabolic pathology.What Can We Expect in the Future?
We can expect that we will have developed a prediction model in which we would be able to anticipate and predict those childhood cancer survivors who are at highest risk of developing cardiopulmonary perturbations, which would allow for targeted interventions.