Cardiovascular Care in Pediatric Cancer Survivors: Updates on Risk, Prevention, and Therapies

Improved survival in pediatric oncology has highlighted the growing burden of cancer treatment-related cardiotoxicity among survivors of childhood cancers. While the cardiotoxicity of anthracyclines and chest radiation are well documented as major contributors of late morbidity and mortality, the rapid adoption of immunotherapies and targeted agents in pediatrics raises new concerns regarding the unknown long-term cardiovascular risk. Recent advances include risk-adapted surveillance protocols and pediatric-based imaging guidelines are important steps towards optimizing early detection and intervention. However, significant gaps persist, particularly in the development of effective treatment options for cardiotoxicity, consistent cardiovascular event reporting, seamless transitions to adult care, and the meaningful integration of machine learning and precision medicine into real-world practice. In light of these ongoing challenges, we believe that while national and international guidelines are an essential framework, optimal cardiology care for pediatric cancer survivors must be grounded in individualized assessment and supported by multidisciplinary collaboration. Ongoing research and innovation are imperative to closing these gaps and advancing the long-term cardiovascular outcomes of this vulnerable population.