Diagnosing and treating heart conditions in children with cancer

Sujeev Mathur is a consultant in paediatric cardiology at Evelina London Children’s Hospital. In this interview he tells us about diagnosing and treating heart conditions in children with cancer.

What is your current role?

I’m a paediatric cardiology consultant. This means I diagnose and treat babies and children with a range of heart conditions. Each year, hundreds of children with cancer in the region also benefit from my experience and expertise as a paediatric cardiologist. 

Why is cardiac care important for children with cancer? 

When a child is diagnosed with cancer, it’s important that the team responsible for the child’s care identifies the most appropriate course of treatment quickly, discusses it with the family and starts it without delay. 

One of the most commonly used and effective types of treatment for childhood cancer, called anthracyclines, are used to treat approximately 70% of childhood cancers. While they are very effective at treating cancer, they can cause damage to the muscle of the heart (cardiomyopathy) and make it weaker. So, it’s important that before, during and after treatment there is close and careful monitoring of the child’s heart. 

That’s where we come in. 

We bring our expert knowledge of diagnosing and treating children with heart conditions to children undergoing cancer treatment. 

We carry out urgent scans of the child’s heart prior to them starting, and throughout the course of treatment, so we have a good understanding of how the heart is functioning beforehand and coping with the cancer treatment. As a paediatric cardiologist with extensive experience of supporting children with cancer, I am in a position to identify any impact of the treatment on the children’s heart quickly and help the cancer team to modify cancer treatment, thereby helping the heart recover. 

Ongoing monitoring is also crucial, long after their cancer treatment has finished, as cardiomyopathy can develop in the years after treatment. As we have the history of the child and their scans we can compare scan results over time, diagnose cardiomyopathy early and start treatment.  As I have special expertise in paediatric imaging, including cardiac MRI, CT scans and echocardiography, I am in a position to use the best imaging methods for individual patients to help monitor their heart function at different stages of their journey. 

What kind of imaging and tests do you use to assess the child’s heart function? 

I work with cardiac physiologists and radiographers and we carry out a range of scans such as cardiac MRI, cardiac CT, and 2D and 3D Echocardiography. We also carry out other tests such as ECG, Holter monitoring and exercise testing.  These tests all compliment each other and help us monitor the patient’s overall heart health over time. 

I also ensure that my patients’ follow up smoothly transitions to my specialist colleague in Guy’s and St Thomas’ adult cardiology services at the appropriate time so their heart health can continue to be monitored on an ongoing basis in line with the current international guidelines.

How common are heart problems for cancer patients?

Approximately 1 in 10 children undergoing cancer treatment with anthracyclines will develop cardiomyopathy in the long term. There are certain risk factors that put them at a higher risk, for example, children who have treatment at a very young age or have high dosages of these drugs during treatment. 

We are able to use advanced echocardiography and a wide range of imaging techniques to enable early diagnosis of cardiomyopathy.  Early initiation of treatment is crucial in slowing down the progression of this condition. 

Why is your role important to you?

I care passionately about children with cancer getting the holistic care and treatment they need from a multi-disciplinary team of specialists experienced in treating children. When a child is diagnosed with cancer, it’s vital that they can start their treatment as soon as possible. 

It goes without saying that the priority for the family and healthcare team is giving a child the best chance of successfully getting rid of the cancer. We also want to do this as safely as possible, minimising the risk of long-term damage to the other organs, particularly the heart.

I care hugely about cancer patients getting access to a world class cardiology service that offers state-of-the-art scans and treatments to identify and treat any impact on the heart as soon as possible to prevent long term damage. 

I am very proud of having established the UK’s only paediatric cardio-oncology service in the UK that offers regular, all day consultant-led clinics specifically for paediatric cardio-oncology patients. Through regular clinics at the Royal Marsden Hospital and outpatient clinics at Evelina London Children’s Hospital, we use our cardiology expertise to make sure that hundreds of children each year during and after cancer treatment get the timely cardiac assessments, diagnoses and treatments they need.