{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T03:42:51Z","timestamp":1778211771371,"version":"3.51.4"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2018,3,30]],"date-time":"2018-03-30T00:00:00Z","timestamp":1522368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Long-term childhood cancer survivors (CCS) are at increased risk of adverse cardiovascular events; however, there is a paucity of risk-stratification tools to identify those at higher-than-normal risk.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Subjects, Materials, and Methods<\/jats:title>\n                  <jats:p>This was a population-based study using data from the Surveillance, Epidemiology, and End Results Program (1973\u20132013). Long-term CCS (age at diagnosis \u226419 years, survival \u22655 years) were followed up over a median time period of 12.3 (5\u201340.9) years. Independent predictors of cardiovascular mortality (CVM) were combined into a risk score, which was developed in a derivation set (n\u2009=\u200922,374), and validated in separate patient registries (n\u2009=\u20096,437).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the derivation registries, older age at diagnosis (\u226510 years vs. reference group of 1\u20135 years), male sex, non-white race, a history of lymphoma, and a history of radiation were independently associated with an increased risk of CVM among long-term CCS (p\u2009&amp;lt;\u2009.05). A risk score derived from this model (Childhood and Adolescence Cancer Survivor CardioVascular score [CHACS-CV], range: 0\u20138) showed good discrimination for CVM (Harrell's C-index [95% confidence interval (CI)]: 0.73 [0.68\u20130.78], p\u2009&amp;lt;\u2009.001) and identified a high-risk group (CHACS-CV \u22656), with cumulative CVM incidence over 30 years of 6.0% (95% CI: 4.3%\u20138.1%) versus 2.6% (95% CI: 1.8%\u20133.7%), and 0.7% (95% CI: 0.5%\u20131.0%) in the mid- (CHACS-CV\u2009=\u20094\u20135) and low-risk groups (CHACS-CV \u22643), respectively (plog-rank\u2009&amp;lt;\u2009.001). In the validation set, the respective cumulative incidence rates were 4.7%, 3.1%, and 0.8% (plog-rank\u2009&amp;lt;\u2009.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>We propose a simple risk score that can be applied in everyday clinical practice to identify long-term CCS at increased cardiovascular risk, who may benefit from early cardiovascular screening, and risk-reduction strategies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications for Practice<\/jats:title>\n                  <jats:p>Childhood cancer survivors (CCS) are known to be at increased cardiovascular risk. Currently available prognostic tools focus on treatment-related adverse events and late development of congestive heart failure, but there is no prognostic model to date to estimate the risk of cardiovascular mortality among long-term CCS. A simple clinical tool is proposed for cardiovascular risk stratification of long-term CCS based on easily obtainable information from their medical history. This scoring system may be used as a first-line screening tool to assist health care providers in identifying those who may benefit from closer follow-up and enable timely deployment of preventive strategies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2017-0502","type":"journal-article","created":{"date-parts":[[2018,3,28]],"date-time":"2018-03-28T16:15:29Z","timestamp":1522253729000},"page":"965-973","source":"Crossref","is-referenced-by-count":8,"title":["Development and Validation of a Clinical Score for Cardiovascular Risk Stratification of Long-Term Childhood Cancer Survivors"],"prefix":"10.1093","volume":"23","author":[{"given":"Evangelos K.","family":"Oikonomou","sequence":"first","affiliation":[{"name":"Cardiology Working Group, Society of Junior Doctors, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofia G.","family":"Athanasopoulou","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals NHS 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