Outcomes following implementation of a pediatric cardio-oncology program

IF 0.6 Q4 PEDIATRICS
Zachary Daniels , Randal Olshefski , Lydia Wright , Stephen Hart , Robert Gajarski , Kan Hor , Deipanjan Nandi
{"title":"Outcomes following implementation of a pediatric cardio-oncology program","authors":"Zachary Daniels ,&nbsp;Randal Olshefski ,&nbsp;Lydia Wright ,&nbsp;Stephen Hart ,&nbsp;Robert Gajarski ,&nbsp;Kan Hor ,&nbsp;Deipanjan Nandi","doi":"10.1016/j.ppedcard.2023.101664","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>With improved survival following childhood cancer, cardiovascular disease has emerged as a significant source of long-term morbidity and mortality. Oncology<span> patients require comprehensive cardiac screening and monitoring throughout their treatment<span> and beyond. The complexity of these patients has led to increasing numbers of pediatric cardio-oncology specialty clinics.</span></span></p></div><div><h3>Objectives</h3><p>To describe the characteristics and 1-year outcomes following cardio-oncology clinic implementation at a large pediatric quaternary care institution.</p></div><div><h3>Methods</h3><p>Patients with history of chest radiation, high-dose anthracycline<span>, or decreased left ventricular function were referred and reviewed. Initiation of oral heart failure therapy or advanced cardiac therapies within 1 year following referral were identified, and risk factors for these were evaluated.</span></p></div><div><h3>Results</h3><p><span>Ninety-seven patients aged 5 days to 21 yrs. old were referred from 2017 to 2021. Average age at cancer diagnosis was 8.1 ± 5.5 years, with 48 % receiving high-dose anthracycline and 36 % chest radiation. Left ventricular dysfunction was present in 28 % at presentation. Oral heart failure therapy was initiated in 31 %, and none required advanced cardiac therapies. Patients who required oral heart failure therapy were more likely to be older at the age of cancer diagnosis, 10.8 ± 5.1 vs. 7.0 ± 5.3 yrs. (</span><em>p</em> = 0.001). A higher proportion of patients who received both high-dose anthracycline and chest radiation were on oral heart failure therapy (4/8, 50 %) compared to patients with high-dose anthracycline (18/46, 39 %) or chest radiation (9/35, 26 %) exposure alone, although not statistically significant.</p></div><div><h3>Conclusion</h3><p>Implementation of a pediatric cardio-oncology clinic led to increased referrals, appropriate assessment, and initiation of oral heart failure therapy. Patients older at the time of cancer diagnosis were more likely to require treatment. However, it does remain unclear if starting a COC provides long-term benefits for this particularly high-risk patient population.</p></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":null,"pages":null},"PeriodicalIF":0.6000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"PROGRESS IN PEDIATRIC CARDIOLOGY","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1058981323000528","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0

Abstract

Background

With improved survival following childhood cancer, cardiovascular disease has emerged as a significant source of long-term morbidity and mortality. Oncology patients require comprehensive cardiac screening and monitoring throughout their treatment and beyond. The complexity of these patients has led to increasing numbers of pediatric cardio-oncology specialty clinics.

Objectives

To describe the characteristics and 1-year outcomes following cardio-oncology clinic implementation at a large pediatric quaternary care institution.

Methods

Patients with history of chest radiation, high-dose anthracycline, or decreased left ventricular function were referred and reviewed. Initiation of oral heart failure therapy or advanced cardiac therapies within 1 year following referral were identified, and risk factors for these were evaluated.

Results

Ninety-seven patients aged 5 days to 21 yrs. old were referred from 2017 to 2021. Average age at cancer diagnosis was 8.1 ± 5.5 years, with 48 % receiving high-dose anthracycline and 36 % chest radiation. Left ventricular dysfunction was present in 28 % at presentation. Oral heart failure therapy was initiated in 31 %, and none required advanced cardiac therapies. Patients who required oral heart failure therapy were more likely to be older at the age of cancer diagnosis, 10.8 ± 5.1 vs. 7.0 ± 5.3 yrs. (p = 0.001). A higher proportion of patients who received both high-dose anthracycline and chest radiation were on oral heart failure therapy (4/8, 50 %) compared to patients with high-dose anthracycline (18/46, 39 %) or chest radiation (9/35, 26 %) exposure alone, although not statistically significant.

Conclusion

Implementation of a pediatric cardio-oncology clinic led to increased referrals, appropriate assessment, and initiation of oral heart failure therapy. Patients older at the time of cancer diagnosis were more likely to require treatment. However, it does remain unclear if starting a COC provides long-term benefits for this particularly high-risk patient population.

儿科心肿瘤项目实施后的结果
随着儿童癌症后生存率的提高,心血管疾病已成为长期发病率和死亡率的重要来源。肿瘤患者需要在整个治疗过程中进行全面的心脏筛查和监测。这些患者的复杂性导致越来越多的儿科心脏肿瘤专科诊所。目的描述一家大型儿科四级医疗机构实施心脏肿瘤学临床治疗后的特点和1年预后。方法回顾性分析有胸部放疗史、大剂量蒽环类药物史或左心室功能减退史的患者。确定转诊后1年内开始口服心力衰竭治疗或高级心脏治疗,并评估这些治疗的危险因素。结果97例患者,年龄5天~ 21岁。老年人从2017年到2021年。癌症诊断的平均年龄为8.1±5.5岁,48%接受高剂量蒽环类药物治疗,36%接受胸部放疗。28%的患者在就诊时出现左心室功能障碍。31%的患者开始口服心力衰竭治疗,没有人需要高级心脏治疗。需要口服心力衰竭治疗的患者在癌症诊断时的年龄更大,分别为10.8±5.1岁和7.0±5.3岁。(p = 0.001)。与单独接受高剂量蒽环类药物(18/ 46,39 %)或胸部放射治疗(9/ 35,26 %)的患者相比,同时接受高剂量蒽环类药物和胸部放射治疗的患者接受口服心力衰竭治疗的比例(4/ 8,50 %)更高,尽管没有统计学意义。结论:儿科心脏肿瘤学门诊的实施增加了转诊,适当的评估和口服心力衰竭治疗的开始。癌症确诊时年龄较大的患者更有可能需要治疗。然而,目前尚不清楚开始COC是否能为这一特别高风险的患者群体提供长期益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
0.90
自引率
11.10%
发文量
69
审稿时长
75 days
期刊介绍: Progress in Pediatric Cardiology is an international journal of review presenting information and experienced opinion of importance in the understanding and management of cardiovascular diseases in children. Each issue is prepared by one or more Guest Editors and reviews a single subject, allowing for comprehensive presentations of complex, multifaceted or rapidly changing topics of clinical and investigative interest.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信