Pediatric Cardio-Oncology Acute Cardiotoxicity Primary and Secondary Prevention Strategies Clinical Pathway

Pathway Background and Objectives

Cardio-oncology is an emerging field. Childhood cancer survivors receive numerous cancer treatments that are cardiotoxic. Among the nearly 400,000 long-term childhood cancer survivors in the United States, more than half were treated with cardiotoxic cancer therapy, which results in a 15-fold increased rate of heart failure and an 8-fold increased rate of premature cardiac death. No comprehensive pediatric cardio-oncology pathway has been published to guide prevention and management of cardiac effects of cancer treatment. A multidisciplinary group, including stakeholders from cardiology, hematology-oncology, hematology-oncology psychosocial team, physical therapy, nutrition, and endocrinology, worked to develop this clinical pathway for primary and secondary prevention of change in systolic function, often referred to as cancer therapy-related cardiac dysfunction (CTRCD). The objectives of this clinical pathway are to:

  • Standardize primary and secondary management of patients receiving cardiotoxic cancer therapy
  • Utilize multimodality imaging to assess for change in systolic performance as indicated
  • Prevent heart failure and the progression of heart failure
  • Ensure appropriate and timely referrals to necessary specialists and ancillary service providers
     

Algorithm  Educational Module

  • Percentage of eligible patients managed appropriately per pathway
  • Percentage of patients that have labs ordered as indicated per pathway
    • If abnormal endocrine labs, percentage of patients with endocrine referral
  • Percentage of patients that have physical therapy assessments performed 
  • Percentage of patients that have nutrition assessments performed 
  • Percentage of patients that have psychosocial assessment performed 
  • Percentage of patients with new cancer diagnosis that receive transitional education 
  • Percentage of patients that have risk scores performed as indicated per pathway
  • Percentage of patients that have CTRCD identified via echo or CMR within a week of time indicated per pathway 
    • If abnormal heart function:
      • Percentage of patients with CTRCD initiated on heart failure treatment
      • Average time to initiation of heart failure treatment

Please refer to pathway educational module for all references with links

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.