Image
Recommendation
Surveillance during treatment – Patients at increased risk of cardiac dysfunction
Consider routine surveillance, preferably with an echocardiogram, of asymptomatic patients considered to be at increased risk of developing cardiac dysfunction. Frequency of surveillance should be determined by patient baseline and future risk of cardiotoxicity.
Routine surveillance imaging may be offered during treatment in asymptomatic patients considered to be at increased risk (Recommendation 1.1) of developing cardiac dysfunction. In these individuals, echocardiography is the surveillance imaging modality of choice that should be offered. Frequency of surveillance should be determined by health care providers based on clinical judgment and patient circumstances (Evidence-based – benefits outweigh harms; evidence quality – intermediate)
There is moderate confidence that the recommendation reflects best practice. This is based on (1) good evidence for a true net effect (eg, benefits exceed harms); (2) consistent results, with minor and/or few exceptions; (3) minor and/or few concerns about study quality; and/or (4) the extent of panelists’ agreement. Other compelling considerations (discussed in the guideline’s literature review and analyses) may also warrant a moderate recommendation
How this guidance was developed
This recommendation was adopted from the ASCO 2017 clinical practice guideline on cardiac dysfunction (US). The source recommendation is based on a systematic review of the evidence conducted to February 2016 and was graded ‘moderate’ (using ASCO methods) by the source guideline authors.
The source recommendation references the high-risk patients which are indicated to include those patients with the following treatments:
-
High-dose anthracyclines (equivalent to ≥250 mg/m2 of doxorubicin or ≥600 mg/m2 of epirubicin
-
Radiation with the heart in the treatment field at a dose of 30 Gray or more
-
A combination of anthracyclines and radiation, even at lower dosages
-
A combination of anthracycline followed by trastuzumab
-
Low-dose anthracycline and other CV risk factors
-
Trastuzumab and other CV risk factors.
More detailed indications for the monitoring of cardiac safety during treatment in patients receiving anthracyclines and anti-HER2 treatments, are provided in the ESMO (2020) guidelines for the management of cardiac disease throughout oncological treatment.
Related guidance by topic
Surveillance during treatment – Patients at increased risk of cardiac dysfunction
Recommendation
Consider routine surveillance, preferably with an echocardiogram, of asymptomatic patients considered to be at increased risk of developing cardiac dysfunction. Frequency of surveillance should be determined by patient baseline and future risk of cardiotoxicity.
Principles in action
Safe and quality care
Image
Multidisciplinary care
Image
Supportive care
Image
Care coordination
Image
Communication
This recommendation was adopted from the ASCO 2017 clinical practice guideline on cardiac dysfunction (US). The source recommendation is based on a systematic review of the evidence conducted to February 2016 and was graded ‘moderate’ (using ASCO methods) by the source guideline authors.
The source recommendation references the high-risk patients which are indicated to include those patients with the following treatments:
-
High-dose anthracyclines (equivalent to ≥250 mg/m2 of doxorubicin or ≥600 mg/m2 of epirubicin
-
Radiation with the heart in the treatment field at a dose of 30 Gray or more
-
A combination of anthracyclines and radiation, even at lower dosages
-
A combination of anthracycline followed by trastuzumab
-
Low-dose anthracycline and other CV risk factors
-
Trastuzumab and other CV risk factors.
More detailed indications for the monitoring of cardiac safety during treatment in patients receiving anthracyclines and anti-HER2 treatments, are provided in the ESMO (2020) guidelines for the management of cardiac disease throughout oncological treatment.
Related guidance by topic
Image
