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Cardiac Care in Children with Cancer and Childhood Cancer Survivors: A Systematic Review of International Clinical Practice Guidelines
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Abstract: (46 Views) |
Background and Objective: With the increasing survival rate of children with cancer, late treatment effects—particularly anthracycline- and chest radiotherapy–induced cardiotoxicity—have emerged as major health challenges in this population. This systematic review aimed to examine and compare the content of international guidelines on cardiac care for children with cancer.
Methods: A systematic search of scientific databases and reputable guideline sources was conducted to identify guidelines specifically addressing the monitoring, prevention, or management of cardiac complications in children with cancer. The quality of the guidelines was assessed using the AGREE II instrument.
Results: Ten international guidelines were included in the review. All emphasized the importance of stratifying patients according to their exposure to cardiotoxic factors and lifelong monitoring of cardiac function. Echocardiography (using ejection fraction and global longitudinal strain) and biomarkers such as NT-proBNP and troponin were the primary monitoring methods recommended. Preventive strategies included the use of dexrazoxane, liposomal anthracycline formulations, and adjusting drug infusion rates. In cases of cardiac dysfunction, most guidelines recommended treatment with angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, based on evidence from adult studies. However, variations existed between guidelines regarding risk classification and monitoring frequency. Quality assessment revealed that some guidelines had weaknesses in stakeholder involvement and in providing actionable implementation strategies.
Conclusion: This systematic review provides a comprehensive overview of the current international guidelines on cardiac care in children with cancer and can serve as a foundation for developing localized guidelines in resource-limited countries such as Iran. Identified gaps highlight the need for prospective research, pediatric-specific clinical trials, and the development of early prognostic indicators. |
Article number: 5 |
| Keywords: clinical practice guideline, cardiac care, children, cancer |
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Full-Text [PDF 941 kb]
(28 Downloads)
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Type of Study: Research |
Subject:
Special
Received: 2025/08/10 | Accepted: 2026/06/17 | Published: 2026/06/25
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