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Editor's Correspondence
February 14, 2011

Cardiac Function in 5-Year Survivors of Childhood Cancer—Reply

Author Affiliations

Author Affiliations: Departments of Medical Oncology (Dr van der Pal), Pediatric Oncology (Drs van der Pal, van Dalen, Caron, van den Bos, and Kremer), Cardiology (Dr Kok), and Radiation Oncology (Drs Oldenburger and Koning), Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; and Departments of Bioinformatics and Statistics (Dr Hauptmann) and Epidemiology (Dr van Leeuwen), Netherlands Cancer Institute, Amsterdam.

Arch Intern Med. 2011;171(3):264-265. doi:10.1001/archinternmed.2010.534

In reply

Rosenberg suggests that our definition of an LVSF of less than 30% as an abnormal cardiac function in a series of asymptomatic adult childhood cancer survivors is inappropriate.1 We respectfully disagree. Our choice was based on the Common Terminology Criteria for Adverse Events (CTC-AE), an established scoring system for both acute and chronic conditions in patients with cancer,2 and using the lower thresholds for children,3 as Rosenberg suggests, is not adequate in our adult population. We acknowledge, however, that any dichotomization of a continuous measurement for the identification of a pathological condition may be overly simplistic. Indeed, the choice of an LVSF threshold for the definition of abnormal cardiac function matters for the prevalence estimate in our study: 27% of the survivors have an LVSF less than 30%, while 20.2% have an LVSF less than 29% and 15% have an LVSF less than 28%. It does, however, not matter for our conclusions on the determinants of decreased LVSF because those were based on linear regression analyses of continuous LVSF.

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