Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers

Published online December 5, 2016, DOI: 10.1200/JCO.2016.70.5400

Saro H. Armenian, Christina Lacchetti, Ana Barac, Joseph Carver, Louis S. Constine, Neelima Denduluri, Susan Dent, Pamela S. Douglas, Jean-Bernard Durand, Michael Ewer, Carol Fabian, Melissa Hudson, Mariell Jessup, Lee W. Jones, Bonnie Ky, Erica L. Mayer, Javid Moslehi, Kevin Oeffinger, Katharine Ray, Kathryn Ruddy, and Daniel Lenihan

Purpose

Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers.

Methods

Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review (1996 to 2016) of meta-analyses, randomized clinical trials, observational studies, and clinical experience. Study quality was assessed using established methods, per study design. The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology.

Results

A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms.

Recommendations

It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy. Certain higher risk populations of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies. Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy. For certain higher risk survivors of cancer, routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy, so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction.

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