Anthracyclines are known for their cardiotoxicity when chemotherapy regimens result in high cumulative exposure. Children who receive chemotherapy for cancer have a higher rate of cardiovascular disease (CVD) and higher mortality rates compared with their siblings without cancer.

Therefore a team of researchers investigated the benefit of using clinical informatics tools to extract data on cumulative anthracycline exposure from a child’s electronic health record (EHR) and use that information to make sure the patient undergoes the appropriate follow-up assessments. Their study results were published in JCO Clinical Cancer Informatics.

“[E]arly diagnosis of treatment-related cardiovascular sequelae represents key targets for interventions aimed at cardioprotection, such as adherence to screening guidelines, preventive care, and healthy lifestyles,” the researchers noted.

Continue Reading

A total of 385 patients aged 18 years and younger at the time of diagnosis were included in the final cohort for analysis. Researchers extracted data about cumulative anthracycline exposure via SQL coding from Clarity, the Epic EHR reporting database. Of the 385 patients, 191 received treatment involving an anthracycline — 48 received a high cumulative dose and 143 an intermediate or low dose. The data analysis revealed documented CVD during or after therapy in patients with high anthracycline exposure (cardiomyopathy in 8.9% of patients, ventricular arrhythmia in 8.9% of patients, and heart failure in 6.7%).

However, the analysis also revealed that 22% of the anthracycline-exposed patients were not adherent to echocardiographic surveillance recommendations established by the Children’s Oncology Group (COG) Long-Term Follow-up Guidelines.

This kind of data capture opens the door for opportunities to catch early cardiovascular disease in children with cancer. “Knowledge gaps for interventions to improve guideline-adherent care for survivors highlight the need for clinical informatics approaches, such as SQL and ICD or CPT coding, to facilitate population health-level solutions,” the researchers explained.

Although this study had a relatively small sample size and lacked robust follow-up to detect late effects, it did show that “longitudinal, interinstitutional collaborations that leverage structured data elements and interoperability within pediatric oncology will be increasingly important as new agents with potential cardiotoxicity change the landscape of survivorship care in the future,” the researchers concluded.

Disclosure: Some study authors declared affiliation with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Noyd DH, Berkman A, Howell C, et al. Leveraging clinical informatics tools to extract cumulative anthracycline exposure, measure cardiovascular outcomes, and assess guideline adherence for children with cancer. JCO Clin Cancer Inform. 2021;5:1062-1075. doi:10.1200/CCI.21.00099