New Guidelines Aim To Prevent Heart Problems in Children Undergoing Cancer Treatment

The world’s first international clinical guidelines to help prevent and treat heart complications in children undergoing cancer treatment have been created.

The guidelines, published in JACC:Advances, cover cardiovascular disease assessment, screening and follow-up, for pediatric patients receiving cancer treatment with new molecular therapies, immunotherapy, chemotherapy and radiotherapy.

The expert consensus, led by researchers from Murdoch Children’s Research Institute, has defined the high-risk group of cancer patients who should undergo a heart check-up, standardised an approach to screening and surveillance during treatment and provided recommendations to protect vulnerable young hearts.

Murdoch Children’s Associate Professor Rachel Conyers ­said while international guidelines to monitor poor heart side effects during therapy exist for adult patients, none were specific to children.

Associate Professor Conyers said the success of new cancer drugs had increased the chances of cardiac side effects that occur early on during therapy, sometimes within days, which warranted closer heart health surveillance and earlier monitoring.

“Recent advances in treating childhood cancer have resulted in survival rates of more than 80 per cent. However, improving serious health outcomes in survivors remains an important and essential focus and prevention is key,” she said.

“Heart complications are a leading cause of death for childhood cancer survivors, second only to cancer relapse. Modern treatments including precision medicine have broadened the agents that can cause heart problems.”

Childhood cancer survivors are 15 times more likely to have heart failure and eight times more likely to have heart disease than the general population.

Toni Bloor’s son, James, 13,  was diagnosed with cardiomyopathy (heart muscle disease) five years after beating cancer.

“The chemotherapy that saved his life has serious side effects for so many children,” she said. For James, that has meant damage to one of his heart valves. He is now on two different medications every day to try and manage the condition.”

Toni said due to the condition James struggled with being active and simple tasks zapped his energy.

“James went from being a little boy who ran and played all day to a child who couldn't do basic things without having to stop for a rest,” she said. He struggles to keep up with us, even when walking, and has to remind us to slow down.” 

Toni said she was hopeful that these guidelines could create a world where ‘life-saving medicine wasn’t life-threatening.’

"We hope that one day a prevention or cure for heart damage from cancer treatment can be found so that these children can live a life free of side effects that could potently take their lives,” she said. “We want James to be able to beat this one too.”

Associate Professor Conyers said the guidelines would be an indispensable tool for clinicians to significantly reduce the harmful impact of cancer drugs on children’s hearts.

“The guidelines are a major advance for the cardio-oncology field as before this there was no defined approach for surveillance or follow up of paediatric patients during treatment despite new therapeutics having early heart complications such as high blood pressure, abnormal heart beats and heart failure,” she said.

The Australian and New Zealand expert group consisted of paediatric and adult cardiologists and paediatric oncologists who undertook a Delphi consensus approach across 11 areas of cardio-oncology care. The Australian New Zealand Children’s Oncology Group endorsed the study with the guidelines useful for any tertiary institutes treating paediatric oncology patients or initiating cardio-oncology clinics.

Reference: Toro C, Felmingham B, Jessop S, et al. Cardio-oncology recommendations for pediatric oncology patients: An Australian and New Zealand Delphi consensus. JACC: Adv. 2022;1(5):100155. doi: 10.1016/j.jacadv.2022.100155

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