Abstract Background There is a growing interest in exploring cancer therapy related cardiotoxicity (CTRC) in the pediatric population. However, a lack of standardized management exists and most guidelines are adapted from the adult counterpart. Purpose This study seeks to evaluate the current practices of cardiological assessment in pediatric cancer patients undergoing treatment in Italy. Methods The study involved the Italian Society of Pediatric Cardiology (SICP) and the Italian Pediatric Hematology-Oncology Association (AIEOP). A 23-item, nation-wide questionnaire was electronically distributed from August 30, 2024, to December 23, 2024, among physicians within the AIEOP network, composed of 49 centers. Sofware Google Modules was employed to create the survey, composed of 4 different sections. For each question the system was set to guide the answer either in multiple choice or in unique feedback. Data was collected into an Excel database for statistical analysis. Results 36 centers partecipated to the survey (response rate 73.5%). Among interviewed centres, 47.2% are general hospitals with a pediatric department, 33.3% pediatric hospitals with oncology-hematology and transplant units. 58.3% of surveyed centers are responsible for the full spectrum of oncological diseases. 83.3% of centers have defined pathways for cardio-oncology. Specifically, in 80.6% of centers the request for cardiological evaluation is detailled with cumulative dose of administered chest radiation or anthracycline. In cases of suspected CTRC, 69.4% of centers adopts biochemical monitoring: 24 centers (68.8%) use NT-proBNP, TnI, and TnT. 9 centers (25.7%) use TnI alone. The left ventricular (LV) ejection fraction (EF) is mostly assessed by Simpson Biplane (2DEF) method (77.8%), whereas strain deformation imaging with GLS is performed in 52.8% of centers. In case of LV dysfunction, to start cardioprotective treatment or modify chemotherapy, 63.9% of centers refers to 2DEF, GLS is adopted in only 13.9% of settings. Cardiac magnetic resonance is used in suspected acute myocarditis (75.8%, 25 centers), or to assess chronic LV dysfunction (63.6% 21 centers). Its use for research purposes is limited (4 centers 12.1%). When treating CTRC, 31 centers (86.1%) use diuretic therapy (ACE inhibitors and sartans), 77.8% of centers use beta-blocker. SGLT2 inhibitors are adopted in only 2 centers. Primary protective mechanisms with liposomal anthracyclines and dexrazosane are recorded in 47.2% and 22.2% of centers, respectively. Changes in oncologic/cardiologic treatment are shared during a multidisciplinary meeting in 83.3% of cases. Conclusions Results reveal significant heterogeneity in practices. A non-homogeneous availability of high-level management for patients affected by CTRC is described. This study unveils the urgent need for unified recommendations to improve cardiologic evaluation, follow up and potentially enhance cardiologic outcomes for pediatric cancer patients.
Pozza et al. (Fri,) studied this question.