354 - Creation and Implementation of a Novel Pediatric Cardio-Oncology Clinical Pathway

Friday, May 3, 2024

5:15 PM – 7:15 PM ET

Poster Number: 354
Publication Number: 354.440

Presenting Author(s)

Olga H. Toro-Salazar, MD (she/her/hers)

Head Non-Invasive Cardiac Imaging, Connecticut Children's. Professor of Pediatrics, University of Connecticut
Connecticut Children's
Hartford, Connecticut, United States

Background: Cardio-oncology is an emerging field. Childhood cancer survivors receive numerous cancer treatments that are cardiotoxic. No comprehensive pediatric cardio-oncology pathway has been published to guide prevention and management of cardiac effects of cancer treatment.

Objective: To develop a comprehensive interdisciplinary pediatric pathway for primary and secondary prevention of cancer therapy-related cardiac dysfunction.

Design/Methods: Key stakeholders for this novel clinical pathway were identified: cardiology, oncology, endocrinology, physical therapy, nutrition, pharmacy, psychosocial team. Stakeholders identified evidence-based content per our institution’s standard process for pathway development. Cardiac imaging parameters were further reviewed by a national expert group.

Results: A Pediatric Cardio-Oncology Acute Cardiotoxicity Primary and Secondary Prevention Strategies pathway was created. A novel pediatric-specific risk score that was previously developed at Connecticut Children’s stratifies patients as low, moderate, or high risk for development of cancer therapy-related cardiac dysfunction. The pathway also includes guidance on preventive interventions, cardiac monitoring (echocardiography and cardiac magnetic resonance imaging), cardiopulmonary stress test, heart failure medication recommendations, and endocrinology lab and referral guidance. The pathway was branded and made available for Connecticut Children’s providers via the Clinical Pathways Program internet site. Pathway end-users were educated on pathway content and utilization.

Conclusion(s): Development and implementation of a clinical pathway for primary and secondary prevention of cancer therapy-related cardiac dysfunction was successful. Next steps are to collect data to ensure the pathway is being utilized for every eligible patient and to track patient outcomes to further improve our capacity to monitor and treat this at-risk patient population.