Expert panel issues first pediatric cardio-oncology guidelines
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An expert panel of pediatric cardiologists and oncologists issued its inaugural cardio-oncology guidelines for the management of pediatric patients receiving anticancer therapy.
In a press release issued by Murdoch Children’s Research Institute, Rachel Conyers, PhD, associate professor in the cardiac regeneration laboratory, stated that although guidelines for diagnosing and managing CV symptoms during anticancer therapy exist, none were specific to children.
Data were derived from Toro C, et al. JACC Adv. 2022;doi:10.1016/j.jacadv.2022.100155.
The expert panel document includes guideline recommendations for identifying high-risk patients for referral to cardio-oncology clinics; overviews the minimum baseline investigations for patients by individual anticancer therapy; and provides guidance for follow-up for patients undergoing anticancer therapy.
“Recent advances in treating childhood cancer have resulted in survival rates of more than 80%. However, improving serious health outcomes in survivors remains an important and essential focus and prevention is key,” Conyers said in the release. “Heart complications are a leading cause of death for childhood cancer survivors, second only to cancer relapse. Modern treatments including precision medicine have broadened the agents that can cause heart problems.”
Utilizing the Delphi consensus approach, 29 experts (51% women; 58% pediatric oncologists; 42% pediatric cardiologists) created cardio-oncology guidelines across 11 domains of cardio-oncology care of pediatric patients: defining high-risk pediatric patients for cardio-oncology referral during acute therapy; the minimum baseline investigations for patients; and surveillance and management for patients with prolonged QT syndrome or receiving anthracycline therapy, VEGF inhibition, rapamycin inhibition, Bcr-Abl tyrosine kinase inhibition, proteasomal inhibition, Bruton’s tyrosine kinase inhibition or immune checkpoint inhibition.
Baseline assessment of high-risk pediatric patients referred to a cardio-oncology clinic included BP, echocardiography, CV global risk assessment, ECG and risk assessment for metabolic syndrome, according to the document.
The guideline also includes medication class-specific assessments following baseline assessment and suggestions for follow-up appointments in the absence of protocol-mandated follow-up.
In addition, Conyers and colleagues created a workflow for the review and use of dexrazoxane cardioprotection for patients who were exposed to anthracycline and/or radiotherapy for cancer treatment.
Please see the document published in JACC: Advances for full details.
“The guidelines are a major advance for the cardio-oncology field, as before this there was no defined approach for surveillance or follow up of pediatric patients during treatment despite new therapeutics having early heart complications such as high blood pressure, abnormal heart beats and heart failure,” Conyers said in the release.
Reference:
- World-first guidelines created to help prevent heart complications in children during cancer treatment. www.mcri.edu.au/news-stories/world-first-guidelines-created-to-help-prevent-heart-complications-in-children-during-cancer-treatment. Published Jan. 26, 2023. Accessed Jan. 30, 2023.
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