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Published in: Cardio-Oncology 1/2024

Open Access 01-12-2024 | Review

A comprehensive pediatric cardio-oncology program: a single institution approach to cardiovascular care for pediatric patients with cancer and childhood cancer survivors

Authors: Nathanya Baez Hernandez, Ksenya Shliakhtsitsava, Drishti Tolani, Cindy Cochran, Ryan Butts, Judith Bonifacio, Elizabeth Journey, Jenna N. Oppenheim, Sarah G. Pennant, Kimberly Arnold, Terri McCaskill, Daniel C. Bowers

Published in: Cardio-Oncology | Issue 1/2024

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Abstract

Cardiovascular complications related to cancer therapies are broad and variable in onset. These complications are the leading cause of non-cancer related morbidity and mortality in childhood cancer survivors and can also impact ongoing cancer treatment. Despite this understanding, dedicated cardio-oncology programs are lacking in pediatric cardiology. In an attempt to respond to these concerns, a risk-stratified, comprehensive cardio-oncology program was established to address the cardiovascular needs including prevention, early diagnosis, and management of patients with and at risk for cardiovascular complications of cancer therapy. This manuscript describes a single institution’s experience of building and managing a multidisciplinary pediatric cardio-oncology program with close collaboration among cardiologists, oncologists, advanced cardiology and oncology practice providers, and allied health providers such as a dietitian and psychologist to provide comprehensive cardiovascular care for childhood cancer patients and survivors. In developing this program, emphasis was on the childhood cancer survivor population, as various cardiovascular complications can present many years after cancer treatment.
Literature
1.
go back to reference National Academies of Sciences, E., et al., in Childhood Cancer and Functional Impacts Across the Care Continuum, L. Aiuppa, et al., Editors et al. 2020, National Academies Press (US) Copyright 2021 by the National Academy of Sciences. All rights reserved.: Washington (DC). National Academies of Sciences, E., et al., in Childhood Cancer and Functional Impacts Across the Care Continuum, L. Aiuppa, et al., Editors et al. 2020, National Academies Press (US) Copyright 2021 by the National Academy of Sciences. All rights reserved.: Washington (DC).
2.
go back to reference Robison LL, Hudson MM. Survivors of childhood and adolescent cancer: life-long risks and responsibilities. Nat Rev Cancer. 2014;14(1):61–70.CrossRefPubMed Robison LL, Hudson MM. Survivors of childhood and adolescent cancer: life-long risks and responsibilities. Nat Rev Cancer. 2014;14(1):61–70.CrossRefPubMed
3.
go back to reference Oeffinger KC, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82.CrossRefPubMed Oeffinger KC, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82.CrossRefPubMed
4.
go back to reference Lipshultz SE, et al. Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association. Circulation. 2013;128(17):1927–95.CrossRefPubMed Lipshultz SE, et al. Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association. Circulation. 2013;128(17):1927–95.CrossRefPubMed
5.
go back to reference Friend AJ, et al. Mental health of long-term survivors of childhood and young adult cancer: a systematic review. Int J Cancer. 2018;143(6):1279–86.CrossRefPubMed Friend AJ, et al. Mental health of long-term survivors of childhood and young adult cancer: a systematic review. Int J Cancer. 2018;143(6):1279–86.CrossRefPubMed
6.
go back to reference Chellapandian D, et al. Congestive heart failure among children with acute leukemia: a population-based matched cohort study. Leuk Lymphoma. 2019;60(2):385–94.CrossRefPubMed Chellapandian D, et al. Congestive heart failure among children with acute leukemia: a population-based matched cohort study. Leuk Lymphoma. 2019;60(2):385–94.CrossRefPubMed
7.
8.
go back to reference van der Pal HJ, et al. Cardiac function in 5-year survivors of childhood cancer: a long-term follow-up study. Arch Intern Med. 2010;170(14):1247–55.PubMed van der Pal HJ, et al. Cardiac function in 5-year survivors of childhood cancer: a long-term follow-up study. Arch Intern Med. 2010;170(14):1247–55.PubMed
9.
go back to reference Armstrong GT, et al. Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27(14):2328–38.CrossRefPubMedPubMedCentral Armstrong GT, et al. Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27(14):2328–38.CrossRefPubMedPubMedCentral
11.
go back to reference Ehrhardt MJ, et al. Systematic review and updated recommendations for cardiomyopathy surveillance for survivors of childhood, adolescent, and young adult cancer from the International Late effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol. 2023;24(3):e108–20.CrossRefPubMed Ehrhardt MJ, et al. Systematic review and updated recommendations for cardiomyopathy surveillance for survivors of childhood, adolescent, and young adult cancer from the International Late effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol. 2023;24(3):e108–20.CrossRefPubMed
12.
go back to reference Ryan TD, et al. The landscape of cardiovascular care in pediatric cancer patients and survivors: a survey by the ACC Pediatric Cardio-Oncology Work Group. Cardiooncology. 2019;5:16.PubMedPubMedCentral Ryan TD, et al. The landscape of cardiovascular care in pediatric cancer patients and survivors: a survey by the ACC Pediatric Cardio-Oncology Work Group. Cardiooncology. 2019;5:16.PubMedPubMedCentral
13.
go back to reference Aziz-Bose R, et al. Delphi Panel Consensus Recommendations for Screening and Managing Childhood Cancer survivors at Risk for Cardiomyopathy. JACC CardioOncol. 2022;4(3):354–67.CrossRefPubMedPubMedCentral Aziz-Bose R, et al. Delphi Panel Consensus Recommendations for Screening and Managing Childhood Cancer survivors at Risk for Cardiomyopathy. JACC CardioOncol. 2022;4(3):354–67.CrossRefPubMedPubMedCentral
14.
go back to reference Kirk R, et al. The International Society for Heart and Lung Transplantation guidelines for the management of pediatric heart failure: executive summary. [Corrected]. J Heart Lung Transpl. 2014;33(9):888–909.CrossRef Kirk R, et al. The International Society for Heart and Lung Transplantation guidelines for the management of pediatric heart failure: executive summary. [Corrected]. J Heart Lung Transpl. 2014;33(9):888–909.CrossRef
15.
go back to reference Sacks N, Desai WE et al. S,., Oncology, hematopoietic transplant, and survivorship. The ASPEN Pediatric Nutrition Support Core Curriculum. 2nd ed, in The ASPEN Pediatric Nutrition Support Core Curriculum 2010. p. 349–377. Sacks N, Desai WE et al. S,., Oncology, hematopoietic transplant, and survivorship. The ASPEN Pediatric Nutrition Support Core Curriculum. 2nd ed, in The ASPEN Pediatric Nutrition Support Core Curriculum 2010. p. 349–377.
16.
go back to reference de Ferranti SD, et al. Cardiovascular Risk Reduction in High-Risk Pediatric patients: A Scientific Statement from the American Heart Association. Circulation. 2019;139(13):e603–34.CrossRefPubMed de Ferranti SD, et al. Cardiovascular Risk Reduction in High-Risk Pediatric patients: A Scientific Statement from the American Heart Association. Circulation. 2019;139(13):e603–34.CrossRefPubMed
17.
go back to reference Belardo D, et al. Practical, evidence-based approaches to nutritional modifications to reduce atherosclerotic Cardiovascular Disease: an American Society for Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol. 2022;10:100323.CrossRefPubMedPubMedCentral Belardo D, et al. Practical, evidence-based approaches to nutritional modifications to reduce atherosclerotic Cardiovascular Disease: an American Society for Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol. 2022;10:100323.CrossRefPubMedPubMedCentral
18.
go back to reference Bashore L, Hobbie W. Emerging and Ongoing Survivorship challenges among Childhood Cancer survivors and providing risk-based focused Follow-Up care. Semin Oncol Nurs. 2021;37(3):151163.CrossRefPubMed Bashore L, Hobbie W. Emerging and Ongoing Survivorship challenges among Childhood Cancer survivors and providing risk-based focused Follow-Up care. Semin Oncol Nurs. 2021;37(3):151163.CrossRefPubMed
19.
go back to reference Mertens L, et al. Multimodality Imaging for Cardiac Surveillance of Cancer Treatment in Children: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2023;36(12):1227–53.CrossRefPubMed Mertens L, et al. Multimodality Imaging for Cardiac Surveillance of Cancer Treatment in Children: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2023;36(12):1227–53.CrossRefPubMed
20.
go back to reference Lyon AR et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS) Eur Heart J, 2022. 43(41): p. 4229–4361. Lyon AR et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS) Eur Heart J, 2022. 43(41): p. 4229–4361.
21.
go back to reference Plana JC, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2014;27(9):911–39.CrossRefPubMed Plana JC, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2014;27(9):911–39.CrossRefPubMed
22.
go back to reference Thavendiranathan P, et al. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol. 2014;63(25 Pt A):2751–68.CrossRefPubMed Thavendiranathan P, et al. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol. 2014;63(25 Pt A):2751–68.CrossRefPubMed
23.
go back to reference Neilan TG, et al. Myocardial extracellular volume by cardiac magnetic resonance imaging in patients treated with anthracycline-based chemotherapy. Am J Cardiol. 2013;111(5):717–22.CrossRefPubMed Neilan TG, et al. Myocardial extracellular volume by cardiac magnetic resonance imaging in patients treated with anthracycline-based chemotherapy. Am J Cardiol. 2013;111(5):717–22.CrossRefPubMed
24.
go back to reference Freyer DR. Transition of care for young adult survivors of childhood and adolescent cancer: rationale and approaches. J Clin Oncol. 2010;28(32):4810–8.CrossRefPubMedPubMedCentral Freyer DR. Transition of care for young adult survivors of childhood and adolescent cancer: rationale and approaches. J Clin Oncol. 2010;28(32):4810–8.CrossRefPubMedPubMedCentral
25.
go back to reference Cardinale D, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation. 2015;131(22):1981–8.CrossRefPubMed Cardinale D, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation. 2015;131(22):1981–8.CrossRefPubMed
26.
go back to reference Tajiri K, Aonuma K, Sekine I. Cardio-oncology: a multidisciplinary approach for detection, prevention and management of cardiac dysfunction in cancer patients. Jpn J Clin Oncol. 2017;47(8):678–82.CrossRefPubMed Tajiri K, Aonuma K, Sekine I. Cardio-oncology: a multidisciplinary approach for detection, prevention and management of cardiac dysfunction in cancer patients. Jpn J Clin Oncol. 2017;47(8):678–82.CrossRefPubMed
27.
go back to reference Fradley MG, et al. Developing a Comprehensive Cardio-Oncology Program at a Cancer Institute: the Moffitt Cancer Center Experience. Oncol Rev. 2017;11(2):340.PubMedPubMedCentral Fradley MG, et al. Developing a Comprehensive Cardio-Oncology Program at a Cancer Institute: the Moffitt Cancer Center Experience. Oncol Rev. 2017;11(2):340.PubMedPubMedCentral
28.
29.
go back to reference Snipelisky D, et al. How to develop a Cardio-Oncology Clinic. Heart Fail Clin. 2017;13(2):347–59.CrossRefPubMed Snipelisky D, et al. How to develop a Cardio-Oncology Clinic. Heart Fail Clin. 2017;13(2):347–59.CrossRefPubMed
30.
go back to reference Lown EA, et al. Psychosocial Follow-Up in Survivorship as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer. 2015;62(Suppl 5):S514–84.PubMedPubMedCentral Lown EA, et al. Psychosocial Follow-Up in Survivorship as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer. 2015;62(Suppl 5):S514–84.PubMedPubMedCentral
31.
32.
go back to reference Hendriks MJ, et al. I don’t take for granted that I am doing well today: a mixed methods study on well-being, impact of cancer, and supportive needs in long-term childhood cancer survivors. Qual Life Res. 2022;31(5):1483–97.CrossRefPubMed Hendriks MJ, et al. I don’t take for granted that I am doing well today: a mixed methods study on well-being, impact of cancer, and supportive needs in long-term childhood cancer survivors. Qual Life Res. 2022;31(5):1483–97.CrossRefPubMed
33.
go back to reference Lubas MM, et al. The contribution of stress and distress to Cardiovascular Health in Adult survivors of Childhood Cancer. Cancer Epidemiol Biomarkers Prev. 2021;30(2):286–94.CrossRefPubMed Lubas MM, et al. The contribution of stress and distress to Cardiovascular Health in Adult survivors of Childhood Cancer. Cancer Epidemiol Biomarkers Prev. 2021;30(2):286–94.CrossRefPubMed
34.
go back to reference Scialla MA et al. Delivery of care consistent with the psychosocial standards in pediatric cancer: current practices in the United States. Pediatr Blood Cancer, 2018. 65(3). Scialla MA et al. Delivery of care consistent with the psychosocial standards in pediatric cancer: current practices in the United States. Pediatr Blood Cancer, 2018. 65(3).
35.
go back to reference Patterson P, et al. The clinical utility of the adolescent and young adult psycho-oncology Screening Tool (AYA-POST): perspectives of AYA Cancer patients and Healthcare professionals. Front Psychol. 2022;13:872830.CrossRefPubMedPubMedCentral Patterson P, et al. The clinical utility of the adolescent and young adult psycho-oncology Screening Tool (AYA-POST): perspectives of AYA Cancer patients and Healthcare professionals. Front Psychol. 2022;13:872830.CrossRefPubMedPubMedCentral
Metadata
Title
A comprehensive pediatric cardio-oncology program: a single institution approach to cardiovascular care for pediatric patients with cancer and childhood cancer survivors
Authors
Nathanya Baez Hernandez
Ksenya Shliakhtsitsava
Drishti Tolani
Cindy Cochran
Ryan Butts
Judith Bonifacio
Elizabeth Journey
Jenna N. Oppenheim
Sarah G. Pennant
Kimberly Arnold
Terri McCaskill
Daniel C. Bowers
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Cardio-Oncology / Issue 1/2024
Electronic ISSN: 2057-3804
DOI
https://doi.org/10.1186/s40959-024-00211-7

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