The landscape of cardiovascular care in pediatric cancer patients and survivors: a survey by the ACC Pediatric Cardio-Oncology Work Group

Thomas D Ryan; William L Border; Carissa Baker-Smith; Ana Barac; Matthew J Bock; Mary M Canobbio; Nadine F Choueiter; Devyani Chowdhury; Katheryn E Gambetta; Julie S Glickstein; Lavanya Kondapalli; Seema Mital; Vasum Peiris; Russell J Schiff; Robert L Spicer; Jeffrey A Towbin; Ming Hui Chen

doi:10.1186/s40959-019-0051-8

The landscape of cardiovascular care in pediatric cancer patients and survivors: a survey by the ACC Pediatric Cardio-Oncology Work Group

Cardiooncology. 2019 Oct 23:5:16. doi: 10.1186/s40959-019-0051-8. eCollection 2019.

Authors

Thomas D Ryan¹, William L Border², Carissa Baker-Smith³, Ana Barac⁴, Matthew J Bock⁵, Mary M Canobbio⁶, Nadine F Choueiter⁷, Devyani Chowdhury⁸, Katheryn E Gambetta⁹, Julie S Glickstein¹⁰, Lavanya Kondapalli¹¹, Seema Mital¹², Vasum Peiris¹³, Russell J Schiff¹⁴, Robert L Spicer¹⁵, Jeffrey A Towbin¹⁶, Ming Hui Chen¹⁷

Affiliations

¹ Heart Institute, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, 3333 Burnet Ave, MLC 2003, Cincinnati, OH 45229 USA.
² 2Children's Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, GA USA.
³ 3Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD USA.
⁴ 4MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA.
⁵ 5Loma Linda University Children's Hospital, Loma Linda, CA USA.
⁶ 6Ahmanson/UCLA ACHD Center, UCLA Health, Los Angeles, CA USA.
⁷ 7The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA.
⁸ Cardiology Care for Children, Lancaster, PA USA.
⁹ 9Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL USA.
¹⁰ 10Morgan Stanley Children's Hospital of New York, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA.
¹¹ 11UC Health Heart & Vascular Center - Anschutz, University of Colorado School of Medicine, Aurora, CO USA.
¹² 12The Hospital for Sick Children, University of Toronto, Toronto, Canada.
¹³ Department of Health and Human Services, Food and Drug Administration Center for Devices and Radiological Health, Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
¹⁴ Cohen Children's Medical Center of New York - Northwell Health, New Hyde Park and Huntington, NY USA.
¹⁵ 15Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, NE USA.
¹⁶ Le Bonheur Children's Hospital, The University of Tennessee Health Science Center, St. Jude Children's Research Hospital, Memphis, TN USA.
¹⁷ Departments of Cardiology and Pediatrics, Boston Children's Hospital, Dana-Farber Cancer Institute/Harvard Cancer Center, and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 USA.

Abstract

Objective: To enhance the understanding of cardiovascular care delivery in childhood cancer patients and survivors.

Study design: A 20-question survey was created by the Pediatric Cardio-oncology Work Group of the American College of Cardiology (ACC) Cardio-oncology Section to assess the care, management, and surveillance tools utilized to manage pediatric/young adult cardio-oncology patients. The survey distribution was a collaborative effort between Cardio-oncology Section and membership of the Adult Congenital and Pediatric Cardiology Section (ACPC) of the ACC.

Results: Sixty-five individuals, all self-identified as physicians, responded to the survey. Most respondents (n = 58,89%) indicated childhood cancer patients are regularly screened prior to and during cancer therapy at their centers, predominantly by electrocardiogram (75%), standard echocardiogram (58%) and advanced echocardiogram (50%) (i.e. strain, stress echo). Evaluation by a cardiologist prior to/during therapy was reported by only 8(12%) respondents, as compared to post-therapy which was reported by 28 (43%, p < 0.01). The most common indications for referral to cardiology at pediatric centers were abnormal test results (n = 31,48%) and history of chemotherapy exposure (n = 27,42%). Of note, during post-treatment counseling, common cardiovascular risk-factors like blood pressure (31,48%), lipid control (22,34%), obesity & smoking (30,46%) and diet/exercise/weight loss (30,46%) were addressed by fewer respondents than was LV function (72%).

Conclusions: The survey data demonstrates that pediatric cancer patients are being screened by EKG and/or imaging prior to/during therapy at most centers. Our data, however, highlight the potential for greater involvement of a cardiovascular specialist for pre-treatment evaluation process, and for more systematic cardiac risk factor counseling in posttreatment cancer survivors.

Keywords: ACC; Cancer; Cardiac risk factors; Cardio-oncology; Cardiology; Echocardiography; Pediatrics; Survey.