Asymptomatic cardiac toxicity in long-term cancer survivors: defining the population and recommendations for surveillance

Abstract

Advances in the treatment of pediatric and adult cancer have reduced the mortality rates from these disorders and have led to an ever-increasing population of long-term survivors. Chemotherapy and radiotherapy may cause premature cardiac disease that may be asymptomatic or symptomatic. All patients exposed to chemotherapy with cardiotoxic potential or chest radiotherapy have stage A heart failure and the goal of surveillance and treatment is to prevent progression to stages B-D. Screening strategies, including the use of biomarkers, echocardiography, and expert opinion surveillance and treatment recommendations, are presented.

Figure 1

Follow-up of asymptomatic survivors exposed to anthracycline chemotherapy and/or chest radiation. * If chest radiation: lipids treated to secondary prevention targets. †If chest/head and neck radiation exposure. ^‡Or at discretion of treating practitioner. ECG, electrocardiogram; Echo, echocardiogram; BNP, B-type natriuretic peptide; BP, blood pressure; exam, examination.