Endocrine Abstracts

Background: CAYA cancer survivors who received cranial radiotherapy have an increased risk of stroke. Traditional cardiovascular disease (CVD) risk factors likely contribute, but there are no guidelines for management of stroke risk in this population. It is unclear how general CVD risk calculators (QRISK3, Framingham Risk Score) compare to specific cancer survivors scores such as the Childhood Cancer Survivors Study Stroke Risk Calculator (CCSS).

Objective: To describe traditional CVD risk factors in an UK CAYA survivor population and compare outcomes of 3 risk calculator models (QRISK3, FRS and CCSS).

Results: 99 CAYA patients (identified from consecutive late effects clinics at a tertiary oncology center: March-May 2021) were included; mean age 35.4 (SD 10.5) years old; mean age at diagnosis 11.8 (SD 5.6) years old, female (46%), Caucasian (86%), active smokers (7%), diabetic (12%), mean HbA1c 39.3 (SD 19.8) mmol/mol, Chol:HDL 3.9 (SD 1.1) and SBP 127 (SD 16) mmHg. Risk factor data available for 89.9%. 90% received cranial radiotherapy; mean dose 47.5 (SD 8.9) Gy. Neoplasms included astrocytoma (23.2%), medulloblastoma (22.2%) and germinoma (13.1%).

For patients with calculable FRS, QRISK3 and CCSS scores, 94.4% (n=17) and 100% (n=38) who had CCSS 10-year stroke risk of 5-20% had a lower predicted risk of CVD using FRS and QRISK3, respectively. Patients who had cranial radiotherapy were more likely to have an underestimated common CVD calculator scores. 6 patients in our cohort had a stroke (CCSS score could not be calculated as >40yrs).

Conclusion: Common CVD risk prediction tools underestimate the risk of stroke compared to the CCSS calculator.