NEW YORK (Reuters Health) - Certain patients with adult cancers face an increased risk of cardiac dysfunction and require monitoring during and after cancer-directed therapies, according to a new clinical practice guideline from the American Society of Clinical Oncology (ASCO).
"While guidelines on prevention and screening for heart problems in children with cancer are well established, comparable guidelines for adults have been lacking," ASCO's Dr. Saro H. Armenian told Reuters Health by email.
"This new ASCO guideline provides evidence-based recommendations to reduce the risk of heart problems in adult patients during and after cancer treatment. Monitoring for heart problems allows for timely interventions that can halt or reverse heart disease," he said.
An expert panel with multidisciplinary representation developed the guideline based on a systematic review of 104 meta-analyses, randomized clinical trials, observational studies, and clinical experience. It was published online December 5 in the Journal of Clinical Oncology.
Patients with cancer who are at increased risk for developing cardiac dysfunction include those who receive high-dose anthracycline and/or radiation therapy; those who receive lower-dose treatment and have cardiovascular risk factors, older age, or already compromised cardiac function; and those who are treated with lower-dose anthracycline followed by trastuzumab.
Before initiating potentially cardiotoxic therapies, clinicians should perform a comprehensive assessment, including an echocardiogram, and should make every effort to avoid or minimize the use of potentially cardiotoxic therapies if there are alternatives available that would not compromise cancer-specific outcomes.
Patients who are receiving potentially cardiotoxic treatments should be monitored for clinical signs or symptoms of cardiac dysfunction. Echocardiography is preferred for diagnostic workup, although cardiac MRI or multi-gated acquisition (MUGA) is acceptable if echocardiography is not available or not technically feasible.
The guideline notes that any decisions regarding continuation or discontinuation of cancer therapy in individuals with evidence of cardiac dysfunction should be made jointly by the oncologist and the cardiologist after considering the risks and benefits of continuation of therapy responsible for the cardiac dysfunction.
Recommendations for monitoring after therapy are similar to those for monitoring during therapy. They include an echocardiogram between six and 12 months after completion of cancer-directed therapy in patients at increased risk of cardiac dysfunction.
Monitoring beyond that point depends upon the findings and upon individual risk factors.
Clinicians are urged to evaluate and manage other cardiovascular risk factors and to discuss the importance of a heart-healthy lifestyle as part of long-term follow-up care.
"Hearing about potential complications from therapy early in the course of the disease can be difficult for patients, as their primary focus is surviving cancer," Dr. Armenian said. "However, clear communication about warning signs and symptoms, as well as appropriate monitoring, can reduce the risk of heart complications."
"The American Heart Association has endorsed this guideline," Dr. Armenian added. "Studies are needed to examine the cardiovascular pathogenic mechanisms associated with cancer treatment, as well as prevention of short- and long-term cardiovascular complications in cancer survivors. Ongoing collaboration between the oncology and cardiology communities is integral to the development of such studies."
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