Delphi Panel Consensus Recommendations for Screening and Managing Childhood Cancer Survivors at Risk for Cardiomyopathy

Aziz‐Bose, Rahela; Margossian, Renée; Ames, Bethany; Moss, Kerry; Ehrhardt, Matthew J.; Armenian, Saro H.; Yock, Torunn I.; Nekhlyudov, Larissa; Williams, David N.; Hudson, Melissa M.; Nohria, Anju; Kenney, Lisa B.

doi:10.1016/j.jaccao.2022.05.010

Cited by 13 publications

(7 citation statements)

References 30 publications

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“…In brief, the summary of LTFU recommendations from 2020 was supplemented by newly developed evidence-based IGHG guidelines published since 2020, in particular addressing ototoxicity [ [23] is in progress but has not been published yet. A recent Delphi Panel Consensus Recommendation has been included to address changes in surveillance intervals that have been proposed during recent years [24].…”

Section: Methodsmentioning

confidence: 99%

Updated International Guidelines for Survivorship Care after Pediatric Cancer: Practice Implications in a German and Austrian Comprehensive Care Network

Gebauer,

Baust,

Bardi

et al. 2023

Oncol Res Treat

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Background: Timely diagnosis of treatment-related chronic health conditions in childhood cancer survivors (CCS) may result in reduced long-term morbidity and mortality. Evidence-based guidelines serve as a tool to implement risk-adapted screening examinations in long-term follow-up (LTFU) of CCS. Summary: New international LTFU guidelines from the last 3 years have been reviewed and included into a practical LTFU tool in order to provide an updated summary of LTFU recommendations. The inclusion of 13 new LTFU guidelines as well as 25 pragmatic recommendations resulted in an updated LTFU plan for implantation in daily practice. Special consideration of psychosocial and mental health aspects as well as recommendations for pregnant CCS complement holistic LTFU care. Key Messages: Risk-adapted LTFU in CCS offers the possibility for early detection and treatment of late effects. As these LTFU recommendations aim at asymptomatic individuals, benefits and potential risks of regular screening examinations have to be carefully balanced. Implementation of current evidence-based guidelines in clinical practice as well as the development of new application tools such as the Survivorship Passport can contribute to an individualized LTFU approach in order to ensure long-term health and quality of life in CCS.

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Section: Methodsmentioning

confidence: 99%

Updated International Guidelines for Survivorship Care after Pediatric Cancer: Practice Implications in a German and Austrian Comprehensive Care Network

Gebauer,

Baust,

Bardi

et al. 2023

Oncol Res Treat

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“…Cardiovascular complications that occur frequently and contribute to late mortality include hypertension (see Renal and Urinary Complications ), dyslipidemia, congestive heart failure, arrhythmias, valvular heart disease, premature coronary artery disease, stroke (see Neurologic and Cognitive Complications ), CHIP (see Hematopoietic Complications ), and peripheral vascular disease ( Table 5 , Supplementary Table S6 ) [ 17 , 22 , 111 – 120 ]. Metabolic syndrome (MetS) includes parameters that together increase the risk for diabetes and cardiovascular disease and is associated with increased all-cause mortality.…”

Section: Cardiac and Vascular Complicationsmentioning

confidence: 99%

International Recommendations for Screening and Preventative Practices for Long-Term Survivors of Transplantation and Cellular Therapy: A 2023 Update

Rotz,

Bhatt,

Hamilton

et al. 2024

Transplantation and Cellular Therapy

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“…GLS has been shown to correlate to traditional cardiovascular risk factors [43]. Clearly, aggressive management of modifiable cardiovascular risk factors is recommended to optimize the cardiac health in CCS [44].…”

Section: Underlying Mechanismsmentioning

confidence: 99%

Childhood Cancer Survivors Have Impaired Strain-Derived Myocardial Contractile Reserve by Dobutamine Stress Echocardiography

Broberg

Øra

Weismann

et al. 2023

JCM

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Abnormal left ventricular contractile reserve (LVCR) is associated with adverse cardiac outcomes in different patient cohorts and might be useful in the detection of cardiomyopathy in childhood cancer survivors (CCS) after cardiotoxic treatment. The aim of this study was to evaluate LVCR by dobutamine stress echocardiography (DSE) combined with measures of myocardial strain in CCS previously treated with anthracyclines (AC). Fifty-three CCS (age 25.34 ± 2.44 years, 35 male) and 53 healthy controls (age 24.40 ± 2.40 years, 32 male) were included. Subjects were examined with echocardiography at rest, at low-dose (5 micrograms/kg/min), and at high-dose (40 micrograms/kg/min) dobutamine infusion. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), strain rate (GSR), and early diastolic strain rate (GEDSR) at different DSE phases were used as measures of LVCR. The mean follow-up time among CCS was 15.8 ± 5.8 years. GLS, GSR, and LVEF were lower at rest in CCS compared to controls (p ≤ 0.03). LVEF was within the normal range in CCS. ΔGLS, ΔGSR, and ΔGEDSR but not ΔLVEF were lower in CCS compared to controls after both low- (p ≤ 0.048) and high-dose dobutamine infusion (p ≤ 0.023). We conclude that strain measures during low-dose DSE detect impaired myocardial contractile reserve in young CCS treated with AC at 15-year follow-up. Thus, DSE may help identify asymptomatic CCS at risk for heart failure and allows for tailored follow-up accordingly.

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Delphi Panel Consensus Recommendations for Screening and Managing Childhood Cancer Survivors at Risk for Cardiomyopathy

Cited by 13 publications

References 30 publications

Updated International Guidelines for Survivorship Care after Pediatric Cancer: Practice Implications in a German and Austrian Comprehensive Care Network

Updated International Guidelines for Survivorship Care after Pediatric Cancer: Practice Implications in a German and Austrian Comprehensive Care Network

International Recommendations for Screening and Preventative Practices for Long-Term Survivors of Transplantation and Cellular Therapy: A 2023 Update

Childhood Cancer Survivors Have Impaired Strain-Derived Myocardial Contractile Reserve by Dobutamine Stress Echocardiography

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