Written By: Longjam Dineshwori | Updated : February 4, 2023 8:01 PM IST
There is a significant amount of stigma associated with cancer. Therefore, not only do the parents have to go through various procedures for their child, but they also have to face the social perception of cancer.
An estimated 4 lakh children and adolescents develop cancer every year, according to the World Health Organization (WHO). Leukemias, brain cancers, lymphomas and solid tumours, such as neuroblastoma and Wilms tumours, are identified to be the most common types of childhood cancers.
"A diagnosis of cancer can be devastating news for the families of pediatric cancer patients. Fortunately, with recent advances in treatment modalities, including chemotherapy, radiotherapy, molecular targeted therapies and immunotherapy, pediatric cancer now has overall survival rates of more than 80 per cent," says Dr. Supratim Sen, Senior Consultant Pediatric Cardiologist, SRCC Children's Hospital, managed by Narayana Health (Haji Ali, Mumbai).
However, he cautions that cancer treatment can have cardiotoxic effects, and put childhood cancer survivors prone to developing heart problems, including heart failure. Speaking to TheHeathSite on World Cancer Day, he shares some ways to prevent/reduce risk of heart problems in kids fighting cancer.
In survivors of childhood cancer, long term outcomes depend not only on the detection and/or prevention of cancer relapse, but also on the early detection and treatment of complications of the treatment given. Some chemotherapy and immunotherapy medications, and also radiotherapy, are known to have cardiotoxic effects, and can cause heart failure in susceptible patients. It is estimated that childhood cancer survivors are 15 times more likely to have heart failure and eight times more likely to have heart disease than the general population.
Heart problems can, however, be detected in very early stages with simple tests, and cardiac treatment can be initiated in these patients to prevent progression and even reverse any cardiac changes. On serial transthoracic echocardiography, we can monitor the pumping function of the heart, the ejection fraction. Newer advanced echo machines also allow us to measure the synchronicity of muscle contraction with the global longitudinal strain. Any decrease in the ejection fraction or global longitudinal strain on routine serial echo can be conveyed to the pediatric oncology team, and the treatment regimen can be adjusted accordingly to prevent progression of heart involvement.
The relatively new multidisciplinary field of Pediatric cardio-oncology deals specifically with the immediate and long-term cardiac effects and outcomes of pediatric cancer survivors. A recent article published in the Journal of the American College of Cardiology: Advances in December 2022 outlined the first pediatric cardio-oncology recommendations by an expert group. This study defined high-risk patients depending on the doses of radiotherapy and chemotherapy that they have or are due to receive as part of their treatment protocols, and also those with underlying congenital heart disease or other cardiac conditions. The study highlighted the importance of periodic cardiology review of these patients along with BP monitoring, ECG, and transthoracic echocardiography. The study also emphasized the importance of patient education and counselling to manage any modifiable cardiovascular risk factors by obesity education, optimization of physical activity, healthy eating, and avoiding smoking. Lastly, the study recommended two groups of medications: dexrazoxane as a cardioprotective agent to be used in high-risk patients receiving high doses of cardiotoxic medicines, and ACE inhibitors as the medication of choice for heart failure and decreasing ventricular function.
With improving survival of pediatric cancer patients, early detection and prevention of cardiac sequelae may become an important aspect in the long-term care of these patients.
