Arising from: Lipshultz SE (2007) Heart failure in childhood cancer survivors. Nat Clin Pract Oncol 4: 334–335 doi:10.1038/ncponc0818

In the June 2007 issue of Nature Clinical Practice Oncology a Practice Point on heart failure in childhood cancer survivors was published. This Practice Point was based on one of our studies (Van Dalen EC et al. Clinical heart failure in a cohort of children treated with anthracyclines: a long-term follow-up study. Eur J Cancer 2006; 42: 3191–3198). We are very pleased with the attention you have given to this important topic. In the synopsis we noticed some errors, however.

First, in the objective it was stated that we have evaluated the risk factors for and cumulative incidence of anthracycline-induced clinical heart failure (A-CHF) in a large group of adult survivors of childhood cancer. This is not correct: as stated on pages 3193 and 3194 of our article, the mean age at last follow-up of patients included in our study was 17.3 years (median 16.7 years; range 0.3–42.7 years). Furthermore, the complete cohort of children treated with anthracyclines in our hospital between 1976 and 2000 was included in our study, irrespective of survival. As a result, we were able to assess the true cumulative incidence of A-CHF from the start of anthracycline treatment. If only survivors had been included, cases of A-CHF occurring during treatment would have been missed and there would have been an underestimation of the incidence of A-CHF after treatment for childhood cancer. Second, in design and intervention it was stated that we defined A-CHF as congestive heart failure that could not be attributed to renal failure, direct effects of the tumor, septic shock or valvular disease. Again, this is not correct: as stated on page 3192 of our article, in our study we defined a case of A-CHF as congestive heart failure, not attributable to other known causes, such as direct medical effects of the tumour, septic shock, valvular disease or renal failure. Since the definition mentioned in the synopsis of our article included only our examples it is too restricted. Also, our definition of congestive heart failure (the presence of the following clinical signs and symptoms: dyspnoea, pulmonary oedema, peripheral oedema, and/or exercise intolerance which were treated with anticongestive therapy, as stated on page 3192 of our article) was not included in the synopsis. To make it possible for readers to correctly interpret the results of our study, it is important that they know the exact definition used.