148 - Evaluating the burden of dyslipidemia in childhood cancer survivors and developing a protocol for screening, detection, and management

Publication Number: 2142.148

Nishi Parikh, University of Illinois College of Medicine, Peoria, IL, United States; Brinda Mehta, University of Illinois College of Medicine Peoria College, Peoria, IL, United States

Background: Following the recurrence of malignancies and neoplasms, cardiovascular (CV)-related effects are the highest contributor to morbidity and mortality of childhood cancer survivors (CCS). CCS are 7 times more likely than the general US population to die from CV-related events. Dyslipidemia is utilized as a marker of metabolic syndrome and atherosclerotic heart disease. Children's Oncology Group has screening guidelines to detect dyslipidemia; however, the current challenge is that the screening guidelines do not include laboratory testing or recommendations for pharmacologic treatment.

Objective: Determine the incidence of hyperlipidemia in CCS at the Children's Hospital of Illinois. Determine how many CCS are eligible for treatment of dyslipidemia and referral to a sub-specialist. Develop a protocol for screening, testing, and treating dyslipidemia, and referral to sub-specialists in CCS.

Design/Methods: Retrospective chart review between 08/2018-12/2024 of CCS over the age of 6 years who are at least 5 years off-therapy having received chemotherapy, radiation, stem cell transplant or a combination. Lipid panels drawn before, during, and following therapy were reviewed. Information on risk factors such as chemotherapy, sites of radiation, and interventions such as lifestyle modification or pharmacotherapy were collected. Patients with known cardiac disease, familial hyperlipidemia, type 2 diabetes mellitus, pregnancy, and tobacco use were excluded.

Results: 123 patients were included in the data, M:F:71:52, with a median age of 14 years (6-22). 56 patients had a lipid panel obtained following completion of therapy. The incidence of dyslipidemia five years after therapy was 50%. Elevated total cholesterol (TC) and triglycerides (TG) were more frequent among patients with hematologic malignancies, whereas low HDL cholesterol appeared more common in those with solid tumors. Odds ratios for elevated TC, LDL, HDL, and TG during therapy ranged between 2.07 and 2.67, though none reached statistical significance (p > 0.05), indicating no strong association between cancer type and dyslipidemia during treatment. 12 (21%) of the patients were referred to a sub-specialist. None of the patients were started on pharmacotherapy.

Conclusion(s): Prior studies have shown that CCS are at risk of dyslipidemia, and ultimately CVD. Our study shows that CCS have an incidence of 50% with children with variation in the type of dyslipidemia in childhood cancer survivors who had a hematological malignancy vs. solid tumor malignancy. Next steps will be to develop a referral and management guidelines for our pediatric cancer survivors.

Patients with documented dyslipidemia 5 years off of therapy
Comparison of dyslipidemia amongst CCS with hematologic malignancies versus solid tumours