Key result
Evaluation in a pediatric cardio-oncology clinic identified cardiovascular toxicities or pre-existing risk factors in 54% of referred patients, most commonly left ventricular dysfunction and hypertension.
Why the study?
Modern oncological therapies can cause cardiac sequelae during active treatment, prompting the need to document cardiovascular toxicities in a dedicated clinic and evaluate Australian and New Zealand surveillance recommendations.
Does a multidisciplinary pediatric cardio-oncology clinic identify previously unrecognized cardiotoxicity in pediatric oncology patients?
Observational (n=37)
No
Does a multidisciplinary pediatric cardio-oncology clinic identify previously unrecognized cardiotoxicity in pediatric oncology patients?
Dedicated pediatric cardio-oncology clinics are effective at identifying previously unrecognized cardiotoxicities, such as hypertension and left ventricular dysfunction, in pediatric patients undergoing cancer treatment.
May justify expanded pediatric cardio-oncology referrals; supports consensus monitoring recommendations with real-world prevalence data.
BACKGROUND: Modern oncological therapies together with chemotherapy and radiotherapy have broadened the agents that can cause cardiac sequelae, which can manifest for pediatric oncology patients while on active treatment. Recommendations for high-risk patients who should be monitored in a pediatric cardio-oncology clinic have previously been developed by expert Delphi consensus by our group. In 2022 we opened our first multidisciplinary pediatric cardio-oncology clinic adhering to these recommendations in surveillance and management. OBJECTIVES: Our pediatric cardio-oncology clinic aimed to: (i) Document cardiovascular toxicities observed within a pediatric cardio-oncology clinic and. (ii) Evaluate the applicability of the Australian and New Zealand Pediatric Cardio-Oncology recommendations. METHODS: Monthly multidisciplinary cardio-oncology clinics were conducted in an Australian tertiary pediatric hospital. Structured standardised approaches to assessment were built into the electronic medical record (EMR). All patients underwent baseline echocardiogram and electrocardiogram assessment together with vital signs in conjunction with standard history and examination. RESULTS: Nineteen (54%) individuals had a documented cardiovascular toxicity or pre-existing risk factor prior to referral. The two most common cardiovascular toxicities documented during clinic review included Left Ventricular Dysfunction (LVD) and hypertension. Of note 3 (8.1%) patients had CTCAE grade III LVD. An additional 10 (27%) patients reviewed in clinic had CTCAE grade I hypertension. None of these patients had hypertension noted within their referral. Cascade testing for cardiac history was warranted in 2 (5.4%) of patients. CONCLUSIONS: Pediatric cardio-oncology clinics are likely beneficial to documenting previously unrecognised cardiotoxicity and relevant cardiac family histories, whilst providing an opportunity to address lifestyle risk factors.
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Toro et al. (2023) conducted an observational in Pediatric cancer (n=37). Multidisciplinary pediatric cardio-oncology clinic assessment was evaluated on Documented cardiovascular toxicity or pre-existing risk factor. Evaluation in a pediatric cardio-oncology clinic identified cardiovascular toxicities or pre-existing risk factors in 54% of referred patients, most commonly left ventricular dysfunction and hypertension.
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