Prevalence and factors associated with left ventricular dysfunction among children on anthracyclines at Uganda Cancer Institute

Abstract

Introduction: The harmful side effects of the various chemotherapeutic agents versus their useful anticancer effects present patient management challenges. Left ventricular dysfunction is one of the early and the most common side effect of anthracyclines which may compromise the clinical effectiveness of chemotherapy, affecting the patient’s survival and quality of life independently of the oncological prognosis. However, little is known about left ventricular dysfunction among children on anthracyclines at Uganda Cancer Institute. Objective: To determine the prevalence and factors associated with left ventricular dysfunction among children on anthracyclines at the Uganda Cancer Institute.

Methods: This was a cross sectional study carried out at the Uganda Cancer Institute from September 2014 to June 2015. Histopathologically confirmed children with cancer aged 6 months to<15years with the baseline Echocardiography and after at least three months to twelve months of anthracyclines used were recruited consecutively until 112 children were enrolled. Informed consent and assent as appropriate were obtained from eligible children. Each child underwent a physical examination and was taken for echocardiography at the Uganda Heart Institute. Cumulative doses of anthracyclines were calculated from the patient previous medical records. Ethical clearance to carry out the study was sought from relevant institutions. Data was recorded into a questionnaire; entered into Epi data 3.1 and was analyzed by STATA version 12.0.

Results: One hundred and twelve patients were enrolled. Sixty four (57.1%) were male thus male: female ratios of 1.3:1. The mean age of the children was 7.4years (SD=4.08); (Age ranges 2-14years). Of the 112 Children enrolled, 15 had left ventricular dysfunction. The prevalence of LVD was therefore 13.4% (95% CI 7.0-19.8).Diastolic function was normal in all the participants using E/A ratios. Cumulative anthracyclines dose above 300mg/m2 was associated with left ventricular dysfunction in this population (p<0.01).

Recommendations: we recommend Serial echocardiography (before each cycle) and other modalities to monitor LV functions of patients on anthracyclines, use of different treatment protocol where feasible to the patient who might receive cumulative dose >300mg/m2 .Large prospective cohort study is also recommended to understand when in time the LVD occurs and to identify more associating factors.