As the population of childhood cancer survivors continues to grow, and as recognition of the cardiovascular risks associated with many cancer treatments increases, the American Heart Association has updated its scientific statement on the cardiovascular care of pediatric patients during — and after — cancer treatment.
The update was published March 19 in Circulation.
Thomas Ryan, MD, PhD, director of the cardio-oncology program and associate director of the heart failure and cardiomyopathy program at Cincinnati Children’s Hospital Medical Center, served as chair for the statement. He shared with Becker’s what the new guidelines mean for cardio-oncology care.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What was the impetus behind developing/updating this scientific statement?
Dr. Thomas Ryan: The last scientific statement on pediatric cardio-oncology was published over a decade ago. While it is considered a seminal reference, the field changes fast, so an update was needed. Our goal was to build on that document by briefly summarizing what it contained while focusing on key new information. We set out to make a concise document that could be easily read but provided direction on where to get more detailed information.
Q: What do cardiology and oncology leaders need to know about integrating early cardiovascular disease risk factor assessments and treatments into pediatric cancer care?
TR: Integrating assessment for cardiovascular disease risk factors in pediatric patients with cancer and beyond is a key message of this scientific statement. It’s well established that the more risk factors present going into treatment, the poorer the outcomes.
Similarly, patients treated for cancer are more likely to have cardiovascular disease risk factors afterward.
Importantly, exercise is in itself a form of medicine that not only improves cardiovascular outcomes, but morbidity and mortality from cancer in general.
Q: What advice do you have for hospital and health system leaders who are trying to build sustainable long-term follow-up or survivorship programs, specifically to ensure pediatric patients treated for cancer can receive appropriate monitoring and care throughout their lives?
TR: As with all our endeavors in taking care of complex patients of any age, communication and collegiality are key. If a hospital wants to develop a pediatric cardio-oncology program or a survivorship program, there has to be buy-in and contribution from all parties involved. This might come in the form of co-leadership between cardiology and oncology, shared research projects and regular meetings of stakeholders.
Even more importantly, advanced practice providers, nurses and other professional colleagues must be involved in planning and carrying out this mission.
Unfortunately, the transition from pediatric to adult care is often rocky, and not all programs have the ability to keep a patient within their system. This is where educating and preparing patients and families is key. Starting the conversation early and taking time over years to ensure an adolescent or young adult fully understands their care and needs moving forward is the best way to ensure they will always advocate for themselves.
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