Outcomes following implementation of a pediatric cardio-oncology program

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.