Pulmonary Hypertension in Children with Cancer

Abstract

Background: The advances in medicine have led to improved survival rates for children diagnosed with cancer. Despite these improvements, late mortality rates for cancer survivors exceed those of the general population. Leading causes of death in this population include subsequent cancer, followed by pulmonary and cardiovascular events. Objective: To study the frequency of pulmonary hypertension in children with cancer after finishing their treatments, and to study the effects of different determined factors like age of diagnosis or type of treatment on the development of pulmonary hypertension. Patient and methods: A cross-sectional study was carried out to focus on the frequency of pulmonary hypertension in patients with cancer after finishing their treatment in Basra Children’s Specialty Hospital, pediatric oncology center over 6 months; from the 1st of October, 2014 till 31th of March 2015. A total of 67 patients were included in the study, their age ranged from 6 months to 16 years, with 41 males and 26 females. The collected patients have been evaluated for development of pulmonary hypertension by Echocardiograph device in same hospital. Results: Acute lymphoblastic leukemia accounts for the greatest percentage (34.3%), followed by Acute myeloid leukemia (15%) then Hodgkin`s lymphoma, (13.4%) and the rest are solid tumors (37.3%). pulmonary hypertension is no statistically significant in relation to type of cancer, (P=0.729). The age of patient at time of diagnoses is statistically significant affects the development of pulmonary hypertension; the frequency tends to occur more in patients who have been diagnosed before the age of five years compared to those diagnosed at age older than 5 years, (P=0.035) but the sex of patient is statistically no significant effect (P=0.773) while no relation to type of treatment with chemotherapy (Methotrexate) radiotherapy is statistically significant (P=0.04). The occurrence of pulmonary hypertension also affected by period after the treatment ,cardiovascular complication is more seen in patient who completed two years after finishing treatment with statistically significant association (P=0.036). Pulmonary hypertension occurred more in patients who exposed to radiation for chest, cervical and brain areas (above diaphragm) than those exposed to abdomen (below diaphragm), but statistically no significant (P=0.264). Route of administration of chemotherapy (Methotrexate) either oral or intravenous on the occurrence of pulmonary hypertension is statistically no significant (P=0.432). Conclusion: The pulmonary hypertension is one of adverse cardiovascular effects that develop in patients who exposed to radiation or certain types of chemotherapy (Methotrexate) so the patient radiotherapy or should have regular screening programs for cardiac functions after complete the course of therapy.