Cardiac outcomes in childhood cancer survivors (CCS): A population-based study.
Bibliographic record
Abstract
10561 Background: CCS are at an elevated risk for cardiac morbidity due to cancer treatments such as anthracycline chemotherapy and thoracic radiation. Morbidities include congestive heart failure (CHF), arrhythmias, valve abnormalities, pericarditis, and coronary artery disease (CAD). However, cohort-based studies have focused primarily on CHF risk. We conducted a population-based study to determine the incidence of all types of cardiac disease in CCS. Methods: Using a provincial pediatric cancer registry, we identified all children < 18 years of age at cancer diagnosis who were treated at a pediatric cancer center in Ontario, Canada between 1987- 2010, and who survived ≥5 years from diagnosis. Each CCS was matched to population controls in a 1:5 ratio by age, sex and geographic region. The index date was 5 years after cancer diagnosis. Administrative health datasets were linked to determine the incidence of CHF, arrhythmias, valve disorders, pericardial disease, CAD (including myocardial infarction), and cardiac-related death using established algorithms. Cumulative incidence of cardiac events was calculated in both cohorts, accounting for competing risks of non-cardiac death and adult cancer events. Results: We studied 7,354 CCS (median diagnosis age 6 years, IQR 2-12) and 36,647 matched controls. During median follow-up of 11 years (IQR 5-17) from index, 2.5% of survivors vs. 0.8% of controls experienced ≥1 cardiac event. At 15 years from index, the cumulative incidence of any cardiac disease was 3.7% (95% CI 3.2-4.3%) in survivors and 1.2% (95% CI 1.1-1.4%) in controls (HR 3.3, CI 2.8-3.9, p < 0.0001). Among survivors, the 15-year cumulative incidence of morbidities was: CHF (2.0%, CI 1.6-2.4%), arrhythmias (1.5%, CI 1.2-1.9%), valve disorders (0.5%, CI 0.3-0.7%), pericardial disease (0.5%, CI 0.3-0.7%), and CAD (0.2%, 95% CI 0.1-0.4%). The 10-year incidence of cardiac-related death was 0.1% (CI 0-0.2%) vs < 0.01% (CI 0-0.03%) in controls. Conclusions: CCS are at elevated risk for multiple types of cardiovascular disease. Their absolute risk at 15-year follow-up is low, but is expected to increase as they age. Follow-up care of CCS should assess and manage general cardiovascular risk rather than limiting to CHF.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".