Cardio-Oncology Recommendations for Pediatric Oncology Patients: An Australian and New Zealand Delphi Consensus

Claudia Toro^{1

2

3}, Ben Felmingham^{1

2}, Sophie Jessop⁴, David S Celermajer^{5

6}, Rishi S Kotecha^{7

8

9}, Dinisha Govender¹⁰, Diane Marie Terese Hanna^{2

11

12}, Matthew O'Connor⁴, Rebecca Manudhane⁴, Julian Ayer^{5

13}, John O'Sullivan^{6

14}, Michael Sullivan^{2

3}, Ben Costello¹⁵, André La Gerche¹⁵, Thomas Walwyn^{16

17}, Lisa Horvath¹⁸, Marion K Mateos^{19

20

21}, Joy Fulbright²², Mangesh Jadhav²³, Michael Cheung^{1

3

23}, David Eisenstat^{2

3}, David A Elliott^{1

3}, Rachel Conyers^{1

2

3}

Affiliations

¹ Cardiac Regeneration Laboratory, Murdoch Children's Research Institute, Parkville, Melbourne, Australia.
² Children's Cancer Centre, The Royal Children's Hospital, Parkville, Melbourne, Australia.
³ Department of Paediatrics, University of Melbourne, Parkville, Australia.
⁴ Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
⁵ Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
⁶ Department of Cardiology, RPA Hospital, Camperdown, New South Wales, Australia.
⁷ Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Australia.
⁸ Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia.
⁹ Curtin Medical School, Curtin University, Perth, Australia.
¹⁰ Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
¹¹ Murdoch Children's Research Institute, Melbourne University, Parkville, Victoria, Australia.
¹² The Walter & Eliza Hall Institute, Parkville, Victoria, Australia.
¹³ The Heart Centre for Children, The Sydney Children's Hospital Network Children's Hospital at Westmead, Westmead, New South Wales, Australia.
¹⁴ Heart Institute, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia.
¹⁵ Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
¹⁶ Department of Paediatric Oncology, Haematology and Bone Marrow Transplantation, Perth Children's Hospital, Nedlands, Western Australia, Australia.
¹⁷ Discipline of Paediatrics, Medical School, University of Western Australia, Perth, Western Australia, Australia.
¹⁸ Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
¹⁹ Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney, Australia.
²⁰ Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia.
²¹ Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, Australia.
²² Division of Pediatric Hematology/Oncology, Children's Mercy Kansas City, Kansas City, Missouri, USA.
²³ Cardiology Department, The Royal Children's Hospital, Melbourne, Australia.

PMID: 38939459
PMCID: PMC11198111
DOI: 10.1016/j.jacadv.2022.100155

Review

Cardio-Oncology Recommendations for Pediatric Oncology Patients: An Australian and New Zealand Delphi Consensus

Claudia Toro et al. JACC Adv. 2022.

. 2022 Dec 30;1(5):100155.

doi: 10.1016/j.jacadv.2022.100155. eCollection 2022 Dec.

Authors

Affiliations

¹ Cardiac Regeneration Laboratory, Murdoch Children's Research Institute, Parkville, Melbourne, Australia.
² Children's Cancer Centre, The Royal Children's Hospital, Parkville, Melbourne, Australia.
³ Department of Paediatrics, University of Melbourne, Parkville, Australia.
⁴ Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
⁵ Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
⁶ Department of Cardiology, RPA Hospital, Camperdown, New South Wales, Australia.
⁷ Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Australia.
⁸ Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia.
⁹ Curtin Medical School, Curtin University, Perth, Australia.
¹⁰ Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
¹¹ Murdoch Children's Research Institute, Melbourne University, Parkville, Victoria, Australia.
¹² The Walter & Eliza Hall Institute, Parkville, Victoria, Australia.
¹³ The Heart Centre for Children, The Sydney Children's Hospital Network Children's Hospital at Westmead, Westmead, New South Wales, Australia.
¹⁴ Heart Institute, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia.
¹⁵ Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
¹⁶ Department of Paediatric Oncology, Haematology and Bone Marrow Transplantation, Perth Children's Hospital, Nedlands, Western Australia, Australia.
¹⁷ Discipline of Paediatrics, Medical School, University of Western Australia, Perth, Western Australia, Australia.
¹⁸ Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
¹⁹ Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney, Australia.
²⁰ Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia.
²¹ Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, Australia.
²² Division of Pediatric Hematology/Oncology, Children's Mercy Kansas City, Kansas City, Missouri, USA.
²³ Cardiology Department, The Royal Children's Hospital, Melbourne, Australia.

PMID: 38939459
PMCID: PMC11198111
DOI: 10.1016/j.jacadv.2022.100155

Abstract

Cardio-oncology is a new multidisciplinary area of expertise that seeks to pre-emptively and proactively address cardiac complications that emerge during and following cancer therapy. Modern therapies including molecular targeted therapy and immunotherapy have broadened the agents that can cause cardiac sequelae, often with complications arising within days to weeks of therapy. Several international guidelines have been developed for the acute monitoring of cardio-oncology side effects. However, none are specific to pediatrics. We have addressed this gap in the literature by undertaking a rigorous Delphi consensus approach across 11 domains of cardio-oncology care using an Australian and New Zealand expert group. The expert group consisted of pediatric and adult cardiologists and pediatric oncologists. This Delphi consensus provides an approach to perform risk and baseline assessment, screening, and follow-up, specific to the cancer therapeutic. This review is a useful tool for clinicians involved in the cardio-oncology care of pediatric oncology patients.

Keywords: acute cardio-oncology; anthracyclines; cardio-oncology; checkpoint inhibitors; frameworks for cardio-oncology; models of care; molecular inhibitors; pediatric oncology; radiation therapy.

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Conflict of interest statement

This study was funded by the 10.13039/100002129Heart Foundation as part of the Strategic Cardio-Oncology Grants (105525). The funder of the study had no role in the study design, data collection, data analysis, data interpretation or the writing of this report. Dr Toro is supported by Children’s Cancer Foundation (CCF). Dr Conyers is supported by the Kids Cancer Project, The Royal Children’s Hospital Foundation, Heart Foundation of Australia, and Victorian Paediatric Cancer Consortium and holds a Murdoch Children’s Research Institute (MCRI) Clinician Scientist Fellowship. Dr Elliott is a member of the Novo Nordisk Foundation Center for Stem Cell Medicine; is supported by a Novo Nordisk Foundation grant number NNF21CC0073729; and is supported by the National Health and Medical Research Council of Australia, Heart Foundation of Australia, and The Medical Research Future Fund. Murdoch Children’s Research Institute is supported by the Victorian Government’s Operational Infrastructure Support Program. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

**Central Illustration**
**This Research Sought to Provide a Framework for Pediatric Oncology Patients Seen During Active Therapy** CTCAE = Common Terminology Criteria for Adverse Events; ECG = electrocardiogram.

**Figure 1**
**Process Leading to Consensus Definitions, Surveillance, and Management Approaches Within PediatricCardio-Oncology**

**Figure 2**
**High-Risk Definition, Minimum Screening, and Follow-Up for Novel Inhibitors** ∗In addition to the baseline assessment, medication class-specific assessments should be conducted at baseline and monitored as appropriate in follow-up appointments. BP = blood pressure; ECG = electrocardiogram; mTOR = mechanistic target of rapamycin; VEGF = vascular endothelial growth factor.

**Figure 3**
**Recommendations for Review and Use of Dexrazoxane Cardioprotection in Patients Exposed to Anthracyclineand/or Radiotherapy**

See this image and copyright information in PMC

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Cardio-Oncology Recommendations for Pediatric Oncology Patients: An Australian and New Zealand Delphi Consensus

Affiliations

Cardio-Oncology Recommendations for Pediatric Oncology Patients: An Australian and New Zealand Delphi Consensus

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

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Full Text Sources

Miscellaneous