Background <p>Paediatric cancer survival rates continue to improve with overall long-term survival now over 80%. A significant proportion of conventional and novel cancer therapies have cardiovascular toxicities which become increasingly relevant as long-term survival improves. At present, within the Italian healthcare setting, a systematic approach to the detection and management of cardiotoxicity in paediatric patients is lacking, and most available recommendations are extrapolated from adult evidence. This study aimed to assess current practices in cardiovascular care delivery for childhood cancer patients and survivors in Italy.</p> Materials and methods <p>An online 23-item nation-wide questionnaire was created by the Italian Society of Paediatric Cardiology (SICP) and the Italian Paediatric Haematology-Oncology Association (AIEOP) to explore the care, management and surveillance tools used to manage cardiotoxicity among paediatric patients and survivors. The survey was distributed among physicians within the AIEOP network.</p> Results <p>Thirty-six of the 49 centres answered to the survey (response rate 73.4%). Most respondents (<i>n</i> = 30, 83.3%) indicated that children are regularly screened for cardiotoxicity. The cardiological evaluation included the following echocardiographic methods to guide decisions on whether to start cardioprotective strategies or modify oncologic treatment protocols: Simpson biplane ejection fraction (EF) (<i>n</i> = 23, 63%) and left ventricle (LV) global longitudinal strain (GLS) (<i>n</i> = 5, 13.9%).</p> Conclusions <p>Results reveal significant heterogeneity in clinical practice among different centres. This report unveils the urgent need for unified recommendations to improve detection and long-term follow-up of cardiotoxicity to enhance cardiologic outcomes of paediatric cancer patients.</p> Graphical Abstract <p></p>