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

Claudia Toro; Ben Felmingham; Sophie Jessop; David S Celermajer; Rishi S Kotecha; Dinisha Govender; Diane Marie Terese Hanna; Matthew O'Connor; Rebecca Manudhane; Julian Ayer; John O'Sullivan; Michael Sullivan; Ben Costello; André La Gerche; Thomas Walwyn; Lisa Horvath; Marion K Mateos; Joy Fulbright; Mangesh Jadhav; Michael Cheung; David Eisenstat; David A Elliott; Rachel Conyers

doi:10.1016/j.jacadv.2022.100155

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

JACC Adv. 2022 Dec 30;1(5):100155. doi: 10.1016/j.jacadv.2022.100155. eCollection 2022 Dec.

Authors

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.

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.

Publication types

Review