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Nutritional status and paediatric anthracycline early cardiotoxicity

Radnyi Mande1, Maya Prasad2,3, Rajul Gala1

  • 1Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.

BMJ Supportive & Palliative Care
|December 18, 2025
PubMed

Insights

Children with Wilms tumour and hepatoblastoma receiving anthracycline therapy face an 11.7% risk of early cardiotoxicity, with undernutrition being a significant contributing factor. Early nutritional assessment and cardiac monitoring are crucial for this vulnerable group.

Area of Science:

  • Pediatric Oncology
  • Cardiology
  • Nutritional Science

Background:

  • Anthracycline chemotherapy is vital for treating pediatric cancers like Wilms tumour (WT) and hepatoblastoma.
  • Cardiotoxicity is a serious concern in children undergoing cancer treatment.
  • The impact of undernutrition on cardiotoxicity in these pediatric patients requires further investigation.

Purpose of the Study:

  • To determine the incidence, patterns, and risk factors of early cardiotoxicity in children with WT and hepatoblastoma.
  • To assess the specific impact of undernutrition on the development of cardiotoxicity.
  • To evaluate the effectiveness of current monitoring and management strategies.

Main Methods:

  • Retrospective cohort study of 137 children treated between 2017 and 2022.
  • Serial echocardiography used for cardiac function monitoring.
  • World Health Organization (WHO) and AHOPCA criteria applied for nutritional status assessment.
  • Multivariable logistic regression analysis to identify risk factors for cardiac dysfunction.

Main Results:

  • The incidence of early cardiotoxicity was 11.7%, with most cases being asymptomatic.
  • Undernutrition, by WHO and AHOPCA criteria, was prevalent and significantly linked to cardiac dysfunction.
  • The majority of affected children showed recovery with medical intervention.

Conclusions:

  • Undernourished children undergoing anthracycline therapy for WT and hepatoblastoma are at a higher risk of early cardiotoxicity.
  • Routine nutritional assessment and early intervention are recommended.
  • Close cardiac monitoring is essential to mitigate acute cardiac toxicity in this high-risk pediatric population.
Abstract

Keywords:
Heart failurePaediatricsSupportive care

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