On this page you can find:

• Who is at risk for cardiac problems?
• What cardiac problems might occur?
• What surveillance modality should be used and at what frequency should it be performed?
• What other advice should be given?
• What should be done if abnormalities are identified?

Who is at risk for cardiac problems?

CAYA cancer survivors treated with

• radiotherapy ≥ 15 Gy to a volume exposing the heart
• anthracyclines
• mitoxantrone

What cardiac problems might occur?

• Cardiomyopathy (after radiotherapy ≥ 15 Gy to a volume exposing the heart and/or anthracyclines ≥ 100 mg/m²)

• Arrhythmia (after radiotherapy ≥ 15 Gy to a volume exposing the heart, anthracyclines or mitoxantrone)
• Pericardial disease (after radiotherapy ≥ 15 Gy to a volume exposing the heart)
• Valvular heart disease (after radiotherapy ≥ 15 Gy to a volume exposing the heart)

What surveillance modality should be used and at what frequency should it be performed?

• A cardiac history at every long-term follow-up visit, at least every 5 years
• A physical cardiac exam at every long-term follow-up visit, at least every 5 years
• An ECG once at entry into long-term follow-up
• An ECG once after the age of 18 years, if entry into long-term follow-up was at a younger age
• An echocardiogram with assessment of left ventricular systolic function:
  • Radiotherapy ≥ 35 Gy to a volume exposing the heart: twice every 5 years, starting 2 years after cardiotoxic therapy
  • Anthracyclines ≥ 100-250 mg/m²: every 5 years, starting 2 years after cardiotoxic therapy
  • Anthracyclines ≥ 250 mg/m²: twice every 5 years, starting 2 years after cardiotoxic therapy
  • Combination of radiotherapy ≥ 15 Gy to a volume exposing the heart and anthracyclines ≥ 100 mg/m²: twice every 5 years, starting 2 years after cardiotoxic therapy
  • Anthracyclines and/or radiotherapy to a volume exposing the heart: prior to pregnancy or in the first trimester ^b
• An echocardiogram with specific attention to the pericardium and valvular structure and function
  • Radiotherapy ≥ 15 Gy to a volume exposing the heart: at least every 5 years, starting 2 years after cardiotoxic therapy
• Not recommended: assessment of cardiac blood biomarkers as the only surveillance strategy

What other advice should be given?

Survivors treated with anthracyclines and/or radiotherapy exposing the heart:

• Screening for modifiable cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity, smoking and physical activity) so that necessary interventions can be initiated to help avert the risk of symptomatic cardiomyopathy

What should be done if abnormalities are identified?

Disclaimer

While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.