For children battling both congenital heart defects (CHD) and cancer, the road to recovery is far more precarious than previously understood, according to a new study published in the Journal of the National Cancer Institute. The research reveals that these children face a higher risk of death within five years after a cancer diagnosis compared to their peers without CHD. Although their survival rates have improved over recent decades, lymphoma mortality remains disproportionately high.
Previous research has shown that children with CHD are at greater risk of developing cancer. For the first time, this study demonstrates that these children also face an increased risk of death within five years after a cancer diagnosis.
The study, a collaboration between researchers in Sweden and Denmark, was conducted as a large, population-based cohort study leveraging national health registers from both countries. In total, nearly 21,000 children diagnosed with cancer between 1970 and 2014 were included, of whom 397 also had a diagnosis of CHD. Researchers examined five-year survival following a cancer diagnosis, comparing outcomes between children with and without CHD.
The findings indicate that children with CHD had a nearly 50 % higher risk of dying within five years of their cancer diagnosis compared to children without CHD. The survival gap was particularly pronounced for children with lymphoma and neuroblastoma. Although survival outcomes for children with CHD improved after 1990 for most cancer types, this progress did not extend to lymphoma, where mortality remained significantly higher.
"Our findings highlight the importance of improving care for children with congenital heart defects who develop cancer," says Christina-Evmorfia Kampitsi, postdoctoral researcher at the Institute of Environmental Medicine, Karolinska Institutet. "To improve survival for these children, effective yet less cardiotoxic cancer treatments are needed, along with tailored care strategies."
Despite considerable advances in childhood cancer care over recent decades, the study underscores persistent challenges faced by this vulnerable group, calling for continued research and targeted interventions. Christina-Evmorfia Kampitsi emphasizes the need to better understand how specific factors affect survival in children with CHD who develop cancer:
"Key areas to explore include treatment regimens, the complexity of the underlying heart defect, and the child's age at cancer diagnosis. Access to larger populations and detailed clinical data will be crucial in addressing these questions."
The study was funded by the Swedish Research Council, Cancerfonden, Barncancerfonden, FORTE, and the Danish Childhood Cancer Foundation.
Publication
Mortality after cancer diagnosis among children with congenital heart disease in Denmark and Sweden
Christina-Evmorfia Kampitsi, PhD, Line Kenborg, PhD, Hanna Mogensen, PhD, Olof Broberg, MD, PhD, Ingrid Glimelius, MD, PhD, Friederike Erdmann, PhD, Jeanette Falck Winther, MD, DMSc, Maria Feychting, PhD, Giorgio Tettamanti, PhD
JNCI: Journal of the National Cancer Institute, djaf010, https://doi.org/10.1093/jnci/djaf010
Published: 17 January 2025
