Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer

Preventing Cardiovascular Complications
As people get older, the risk for developing cardiovascular problems, such as heart attack and stroke, increases.
Additional factors that increase the risk of developing cardiovascular problems include:•Being overweight or obese•

High blood pressure•

Unhealthy cholesterol levels (high LDL, high triglycerides, or low HDL)

•Prediabetes or diabetes mellitus•

Smoking•

Excessive alcohol intake•

Family history of heart disease

Certain cancer treatments given during childhood, adolescence, or young adulthood may increase the risk of developing
cardiovascular complications. It is important for you to be aware of these risks so that you can practice healthy habitsthat can help prevent cardiovascular problems.
What increases the risk for being overweight or obese?
Treatment factors:•Radiation to the brain or head (especially at doses of 18 Gy or higher)•

Surgery to the brain affecting the “mid-brain” area (containing the pituitary gland)

Other known risk factors:•Overeating•

Eating a diet that is high in fats and sugar•

Not having regular physical activity•

Having certain medical conditions, like an underactive thyroid (hypothyroidism), or low levels of GH

What increases the risk for high blood pressure?
Treatments factors:•Ifosfamide•

Cisplatin•

Carboplatin•

Radiation involving the kidneys, including the abdomen, flank, and total body irradiation (TBI)•

Removal of one kidney (see related Health Link: Single Kidney Health)•Hematopoietic cell transplant (particularly if complicated by chronic graft-versus-host disease)

Other known risk factors:•Being overweight or obese•

Having a family history of high blood pressure

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Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer•

Not getting regular physical activity•

Eating a diet that is high in salt

What increases the risk for unhealthy cholesterol levels (including high triglycerides and lowHDL)?
Treatment factors:•Total body irradiation (TBI)•Abdominal radiation

Other known risk factors:•

Being overweight or obese•

Having a family history of unhealthy cholesterol levels•

Not getting regular physical activity•

Eating a diet high in fat

What increases the risk for high blood sugar/diabetes mellitus?
Treatment factors:•

Abdominal radiation•

Total body irradiation (TBI)•

Prolonged treatment with corticosteroids, such as prednisone or dexamethasone

Other known risk factors:•

Being overweight or obese (note that survivors who received TBI may be at increased risk even if they are notoverweight or obese)•Having a family history of diabetes

How I can I tell if I am overweight or obese?
Visit with your health care provider about your weight to determine if you are at a healthy weight for your height,
age and activity level. The body mass index (BMI) is a tool your provider may use to help determine if you are at ahealthy weight. BMI calculators and information on how to interpret results are available on-line at www.cdc.gov/
healthyweight/assessing/bmi/.
What can I do to lower my risk of cardiovascular complications?
•Get regular check-ups and follow your health care provider’s recommendations regarding how often you needblood pressure checks and blood tests to monitor your cholesterol and/or blood sugar levels.

•Eat a healthy diet (See related Health Link: Staying Health through Nutrition and Physical Activity).

•Increase physical activity if you are able (See related Health Link: Staying Health through Nutrition and PhysicalActivity).

•Avoid smoking. If you are interested in quitting smoking, online assistance is available from the National
Institutes of Health at www.smokefree.gov.

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Healthy living after treatment of childhood, adolescent, and young adult cancer•

If you are overweight, obese, have high blood pressure, unhealthy cholesterol levels and/or high blood sugar,
see your health care provider regularly. Follow their recommendations for additional testing, if needed, and forongoing treatment of your health condition.

•In some cases, medications may be required to treat these conditions. If you are prescribed medications, be sure
to take them regularly and to carefully follow your health care provider’s instructions.

Written by Adam J. Esbenshade, MD, MSci, Vanderbilt University/Ingram Cancer Center, Nashville, TN.
Reviewed by Linda Rivard, RN, BSN, CPON; Melissa Acquazzino, MD, MS; and Kayla L. Foster, MD, MPH.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or youngadulthood.
Disclaimer and Notice of Proprietary Rights
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health
Links were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’sOncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding a
medical condition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.
To physicians and other healthcare providers: The Informational Content is not intended to replace your independent clinical judgment, medical advice, or to exclude other legitimate
criteria for screening, health counseling, or intervention for specific complications of childhood cancer treatment. Neither is the Informational Content intended to exclude other reasonable
alternative follow-up procedures. The Informational Content is provided as a courtesy, but not intended as a sole source of guidance in the evaluation of childhood cancer survivors. The
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