# Pediatric Cardio-Oncology: From Gap in Evidence to Future Perspectives

## TL;DR

This paper reviews the challenges in managing heart-related side effects in childhood cancer survivors and highlights the need for better research and standardized care.

## Contribution

The paper identifies critical gaps in evidence and proposes future research directions to improve cardiovascular care for pediatric cancer survivors.

## Key findings

- Cardiotoxicity is a major cause of non-relapse-related morbidity and mortality in childhood cancer survivors.
- There is significant variability in clinical practice due to a lack of standardized surveillance and prevention protocols.
- International collaborative research is urgently needed to advance predictive and preventive pediatric cardio-oncology.

## Abstract

Improved survival rates for paediatric cancer patients represent a major medical achievement, but they have simultaneously brought the long-term sequelae of oncological treatments into sharp focus. Cardiotoxicity stands out as one of the most serious complications, being the leading cause of non-relapse-related morbidity and mortality among childhood cancer survivors. This comprehensive review analyses the current landscape, highlighting the significant gap in evidence that hinders optimal care. This paper constitutes a comprehensive narrative and scoping review based on a critical analysis of current clinical guidelines, landmark studies, and consensus papers in paediatric cardio-oncology. Crucially, it assesses the heterogeneity and limitations of existing evidence regarding standardized surveillance protocols, primary prevention strategies, and acute/late-onset cardiovascular complication management. The review then identifies and critically discusses key areas for future research and clinical development. A critical gap in evidence persists in paediatric cardio-oncology, leading to significant variability in clinical practice and the underdiagnosis/undertreatment of cardiovascular risk factors in this vulnerable population. To bridge this gap, there is an urgent need for international collaborative research. The overarching goal is to transform paediatric cardio-oncology into a predictive and preventive speciality, ensuring that all childhood cancer survivors achieve not only extended life expectancy but also improved cardiovascular quality of life.