Heart disease in survivors of childhood cancer: Data from the German Childhood Cancer Registry and statutory health insurance carriers (the VersKiK study)

BACKGROUND: Cardiac and cardiovascular diseases are major causes of morbidity in the growing population of childhood cancer survivors, particularly as a result of treatment with anthracyclines and radiotherapy to the chest. METHODS: The VersKiK study is based on record linkage between the German Childhood Cancer Registry and 13 statutory health insurance carriers (69% coverage of the German statutorily insured population). Registry data with information on primary cancers in childhood or adolescence were linked to data from the participating health insurance carriers. Cardiac diseases were analyzed in 11 863 patients with cancer diagnosed between 1991 and 2011 who survived at least 5 years after their diagnosis (up to January 2017). The health insurance data covered the years 2017-2021. The childhood cancer survivors were matched to a comparison group of 35 589 insurees without childhood cancer by age, sex, region of residence within Germany, and duration of insurance. RESULTS: Cardiac diseases were identified in 6.4% of the 5-year survivors of childhood cancer and in 2.5% of the matched comparison group. Cardiomyopathy, valvular disease, and arrhythmia were the most common heart diseases in the survivors (1.9%, 2.7%, 1.5%). The largest difference from the comparison group was observed for cardiomyopathy (prevalence ratio = 14.0; 95% confidence interval: [10.9; 20.5]). CONCLUSION: Long-term survivors of childhood cancer in Germany are more likely to be diagnosed with cardiac disease than the general population of the same age. Systematic medical monitoring and individualized preventive measures for survivors are indicated. In the interpretation of these findings, it should be noted that the childhood cancer survivors underwent more intensive long-term medical follow-up than their counterparts in the comparison group.