Lessons learnt in the first year of an Australian pediatric cardio oncology clinic

Claudia Toro; Ben Felmingham; Mangesh Jhadav; David S Celermajer; Andre La Gerche; John O'Sullivan; Sanjeev Kumar; Marion K Mateos; Joy Fulbright; Dinisha Govender; Lane Collier; Michael Cheung; David D Eisenstat; Peter W Lange; Julian Ayer; David A Elliott; Rachel Conyers

doi:10.1186/s40959-023-00194-x

Lessons learnt in the first year of an Australian pediatric cardio oncology clinic

Cardiooncology. 2023 Dec 7;9(1):45. doi: 10.1186/s40959-023-00194-x.

Authors

Claudia Toro^{1

2

3}, Ben Felmingham^{1

2}, Mangesh Jhadav⁴, David S Celermajer^{5

6}, Andre La Gerche⁷, John O'Sullivan⁶, Sanjeev Kumar⁸, Marion K Mateos^{9

10

11}, Joy Fulbright¹², Dinisha Govender¹³, Lane Collier¹, Michael Cheung^{1

4}, David D Eisenstat^{2

3}, Peter W Lange^{14

15}, Julian Ayer^{16

17}, David A Elliott^#^{2

3

7}, Rachel Conyers^#^{18

19

20}

Affiliations

¹ Cardiac Regeneration Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, Melbourne, 3052, Australia.
² Children's Cancer Centre, The Royal Children's Hospital, Flemington Road, Parkville, Melbourne, 3052, Australia.
³ Department of Pediatrics, University of Melbourne, Flemington Road, Parkville, Melbourne, 3052, Australia.
⁴ Cardiology Department, The Royal Children's Hospital, Parkville, Melbourne, 3052, Australia.
⁵ Sydney Medical School, University of Sydney, Sydney, NSW, 2050, Australia.
⁶ Dept of Cardiology, RPA Hospital, Sydney, NSW, 2050, Australia.
⁷ Clinical Research Domain, Baker Heart and Diabetes Institute Commercial Road, Melbourne, VIC, 3004, Australia.
⁸ Chris O'Brien Lifehouse Camperdown, Sydney, NSW, 2050, Australia.
⁹ Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney, Australia.
¹⁰ Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney, Australia.
¹¹ Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, Australia.
¹² Division of Pediatric Hematology/Oncology, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
¹³ Cancer Centre for Children, The Children's Hospital, Corner of Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia.
¹⁴ Department of Geriatrics, University of Melbourne, Parkville, Melbourne, 3052, Australia.
¹⁵ Werribee Mercy Hospital, Werribee, Melbourne, Australia.
¹⁶ The Heart Centre for Children, The Sydney Children's Hospital Network Children's Hospital, Westmead, Sydney, NSW, Australia.
¹⁷ Medicine and Dentistry Clinical School, The University of Sydney, Sydney, NSW, Australia.
¹⁸ Cardiac Regeneration Laboratory, Murdoch Children's Research Institute, Flemington Road, Parkville, Melbourne, 3052, Australia. rachel.conyers@mcri.edu.au.
¹⁹ Children's Cancer Centre, The Royal Children's Hospital, Flemington Road, Parkville, Melbourne, 3052, Australia. rachel.conyers@mcri.edu.au.
²⁰ Department of Pediatrics, University of Melbourne, Flemington Road, Parkville, Melbourne, 3052, Australia. rachel.conyers@mcri.edu.au.

^# Contributed equally.

Abstract

Background: Modern oncological therapies together with chemotherapy and radiotherapy have broadened the agents that can cause cardiac sequelae, which can manifest for pediatric oncology patients while on active treatment. Recommendations for high-risk patients who should be monitored in a pediatric cardio-oncology clinic have previously been developed by expert Delphi consensus by our group. In 2022 we opened our first multidisciplinary pediatric cardio-oncology clinic adhering to these recommendations in surveillance and management.

Objectives: Our pediatric cardio-oncology clinic aimed to: (i) Document cardiovascular toxicities observed within a pediatric cardio-oncology clinic and. (ii) Evaluate the applicability of the Australian and New Zealand Pediatric Cardio-Oncology recommendations.

Methods: Monthly multidisciplinary cardio-oncology clinics were conducted in an Australian tertiary pediatric hospital. Structured standardised approaches to assessment were built into the electronic medical record (EMR). All patients underwent baseline echocardiogram and electrocardiogram assessment together with vital signs in conjunction with standard history and examination.

Results: Nineteen (54%) individuals had a documented cardiovascular toxicity or pre-existing risk factor prior to referral. The two most common cardiovascular toxicities documented during clinic review included Left Ventricular Dysfunction (LVD) and hypertension. Of note 3 (8.1%) patients had CTCAE grade III LVD. An additional 10 (27%) patients reviewed in clinic had CTCAE grade I hypertension. None of these patients had hypertension noted within their referral. Cascade testing for cardiac history was warranted in 2 (5.4%) of patients.

Conclusions: Pediatric cardio-oncology clinics are likely beneficial to documenting previously unrecognised cardiotoxicity and relevant cardiac family histories, whilst providing an opportunity to address lifestyle risk factors.

Keywords: Cardio-oncology; Cascade testing; Hypertension; Left ventricular dysfunction; Pediatric cancer; Pediatric cardio-oncology; Pediatric oncology.