Cardio-Oncology

Frequently Asked Questions

Any disorder affecting the cardiovascular system due to hematology, oncology and stem cell transplant therapies in pediatric, adolescent and young adult patients can be treated. 

Commonly, this includes:

• Decreased function of the heart, sometimes called ventricular dysfunction or heart failure
• Abnormal heart rhythms
• High blood pressure
• Fluid around the heart (pericardial effusion)
• Abnormal heart valve function

The effects of hematology-, oncology- and stem cell transplant-related therapies in pediatric, adolescent and young adult patients can occur after a single dose, or years to decades later.

It is important to remember that not all patients who have received these therapies develop cardiovascular disease, and overall it is rare.

Patients seen in the Cardio-Oncology Program include any patients treated by hematologists, oncologists and stem cell transplant specialists at Cincinnati Children’s or at other medical centers, referring specialists, primary care providers and self-referring families.

Our program cares for pediatric, adolescent and young adult patients who:

• Are undergoing active treatment
• Have completed treatment
• Have been previously diagnosed with heart problems, including congenital heart disease
• Are at risk of developing cardiovascular complications due to treatment

We offer both an inpatient consultation service as well as a dedicated outpatient clinic. Patients seen in the cardio-oncology outpatient clinic are treated by a team of specialized providers.

While any number of chemotherapy medications can lead to cardiovascular disease in pediatric, adolescent and young adult patients, the most common are anthracyclines (for example, doxorubicin and mitoxantrone) and radiation therapy.

Other medicines shown to have effects on the cardiovascular system include cyclophosphamide, tyrosine kinase inhibitors and small molecule biological agents.

In addition to these medications, radiation therapy, alone and particularly in combination with medications, can lead to cardiovascular disease.

Not all patients who receive these therapies will develop cardiovascular disease, and overall it is rare.

The effects of hematology-, oncology- and stem cell transplant-related therapies in pediatric, adolescent and young adult patients can occur after a single dose, or years to decades later.

It is important to remember that not all patients who have received these therapies develop cardiovascular disease, and overall it is rare.

Additionally, we are not able to predict who it will happen to or when, so ongoing follow-up is needed.

Conventional wisdom is the best advice in this case, including living a heart-healthy lifestyle that includes an appropriate diet, regular exercise and avoidance of risk factors such as smoking.

There are ongoing clinical trials to identify agents that may help to protect pediatric, adolescent and young adult patients against developing cardiovascular disease.

No particular supplement is recommended.

Ultimately, following up with your oncologist and recommended testing, even once your therapy is complete, is the best safeguard.

This answer depends on what cardiovascular disease has developed.

Sometimes no therapy is needed and a condition is simply monitored.

At other times, medicines are used to control heart rate, blood pressure or improve heart function in pediatric, adolescent and young adult patients.

Rarely, other medical and surgical interventions are needed.

These are all in addition to adjusting to a heart-healthy lifestyle.

• Anthracycline – type of chemotherapy most commonly associated with cardiovascular side effects
• Arrhythmia – abnormal heart rhythm. This may range from “skipped” or “extra” beats to risky heart rhythms.
• Cardiology – the branch of medicine that deals with diseases of the heart
• Cardiomyopathy – heart muscle disease
• Cardio-oncology – the branch of cardiology care focused on disease in patients who have had therapy for cancer, bone marrow failure or blood disorders
• Heart failure – inability of the heart to perform the work needed by the body, which may include symptoms such as activity intolerance / fatigue, abdominal pain, swelling or breathing difficulties
• Pericardial effusion – fluid collection around the heart. This may range from needing no therapy to requiring drainage emergently.
• Ventricular dysfunction – may describe abnormal squeeze of the heart, relaxation, or both

Yes, Cincinnati Children's Cancer Survivorship Center provides specialized medical care and psychosocial support to childhood cancer survivors, including pediatric, adolescent and young adult patients treated for cardiovascular disease due to hematology, oncology and stem cell transplant therapies.

Established over 25 years ago as one of the first of its kind in the country, the Cancer Survivorship Center is able to see survivors through adulthood even if they were treated for their initial pediatric, adolescent and young adult cancer elsewhere.

The program is designed for people who were diagnosed with a pediatric cancer at least five years ago and completed treatment for their cancer at least two years ago.

Patients remain under the care of their primary care physician, returning to the Survivorship Center annually for an evaluation and risk based assessments.

Learn more about the Cincinnati Children's Cancer Survivorship Center.