Table 2.
Hazard ratios and 95% confidence intervals of reported cardiac conditions in childhood cancer survivors, by treatment
| Congestive heart failure | Myocardial infarction | Pericardial disease | Valvular abnormalities | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HR | 95% CI | P value | HR | 95% CI | P value | HR | 95% CI | P value | HR | 95% CI | P value | |
| Gender | ||||||||||||
| Male | 1.0† | — | — | 1.0† | — | — | 1.0† | — | — | 1.0† | — | — |
| Female | 1.4 | 1.1–1.9 | 0.018 | 0.6 | 0.4–0.9 | 0.014 | 1.3 | 0.9–1.8 | 0.15 | 1.6 | 1.2–2.1 | 0.003 |
| Age at diagnosis | ||||||||||||
| 0–4 years | 3.9 | 2.1–7.3 | <0.001 | 1.0 | 0.4–3.0 | 0.96 | 1.8 | 0.9–3.8 | 0.13 | 2.7 | 1.4–5.3 | 0.004 |
| 5–9 years | 2.3 | 1.3–4.0 | 0.004 | 1.9 | 0.9–4.0 | 0.090 | 1.3 | 0.7–2.5 | 0.44 | 2.5 | 1.5–4.3 | 0.001 |
| 10–14 years | 1.2 | 0.8–1.9 | 0.37 | 0.8 | 0.4–1.5 | 0.49 | 0.8 | 0.5–1.3 | 0.41 | 1.5 | 1.0–2.2 | 0.050 |
| 15–20 years | 1.0† | — | — | 1.0† | — | — | 1.0† | — | — | 1.0† | — | — |
| Treatment era | ||||||||||||
| 1970–4 | 1.0† | — | — | 1.0† | — | — | 1.0† | — | — | 1.0† | — | — |
| 1975–9 | 1.1 | 0.7–1.7 | 0.60 | 2.1 | 1.2–3.8 | 0.010 | 1.5 | 1.0–2.4 | 0.078** | 1.4 | 1.0–2.0 | 0.090** |
| 1980–6 | 1.9 | 1.2–3.0 | 0.008 | 2.2 | 1.1–4.3 | 0.023 | 1.4 | 0.8–2.4 | 0.25 | 1.8 | 1.2–2.9 | 0.008 |
| Average cardiac radiation dose§ | ||||||||||||
| No cardiac radiation | 1.0† | — | — | 1.0† | — | — | 1.0† | — | — | 1.0† | — | — |
| <500 cGy | 0.9 | 0.6–1.4 | 0.75 | 0.7 | 0.4–1.4 | 0.36 | 0.7 | 0.4–1.1 | 0.11 | 0.6 | 0.4–1.0 | 0.063 |
| 500 to <1500 cGy | 1.3 | 0.7–2.5 | 0.43 | 0.6 | 0.1–2.5 | 0.45 | 1.9 | 0.9–3.9 | 0.077 | 1.4 | 0.7–2.9 | 0.40 |
| 1500 to <3500 cGy | 2.2 | 1.4–3.5 | <0.001 | 2.4 | 1.2–4.9 | 0.011 | 2.2 | 1.3–3.9 | 0.005 | 3.3 | 2.1–5.1 | <0.001 |
| ≥3500 cGy | 4.5 | 2.8–7.2 | <0.001 | 3.6 | 1.9–6.9 | <0.001 | 4.8 | 2.8–8.3 | <0.001 | 5.5 | 3.5–8.6 | <0.001 |
| Chemotherapy | ||||||||||||
| Anthracycline v none¶ | ||||||||||||
| <250 mg/m2 | 2.4 | 1.5–3.9 | <0.001 | 1.3 | 0.6–2.8 | 0.50 | 1.6 | 0.9–2.9 | 0.13 | 1.4 | 0.8–2.3 | 0.25 |
| ≥250 mg/m2 | 5.2 | 3.6–7.4 | <0.001 | 1.1 | 0.5–2.1 | 0.87 | 1.8 | 1.1–3.0 | 0.020 | 2.3 | 1.6–3.3 | <0.001 |
| Cisplatin v none | 1.7 | 0.9–2.9 | 0.062 | ‡ | ‡ | — | ‡ | ‡ | — | ‡ | ‡ | — |
| Vincristine v none | ‡ | ‡ | — | 0.7 | 0.4–1.1 | 0.081 | ‡ | ‡ | — | ‡ | ‡ | — |
| Bleomycin v none | ‡ | ‡ | — | ‡ | ‡ | — | 1.6 | 0.9–2.9 | 0.091 | ‡ | ‡ | — |
| Cyclophosphamide v none | ‡ | ‡ | — | ‡ | ‡ | — | 1.5 | 1.0–2.3 | 0.049** | ‡ | ‡ | — |
CI = confidence interval
HR = hazard ratio
*
Estimates adjusted for all variables in the table as well as race, household income, education, and tobacco use.
†
Reference group.
‡
Not included in model.
§
Test for trend (P-value)-all outcomes (<0.001).
¶
Test for trend (P-value)-congestive heart failure (<0.001), myocardial infarction (0.8), pericardial disease (0.03), valvular disease (<0.001).
**
Not significant at P=0.05