Cardiac Toxicity and Cancer Treatment Monitoring

Monitoring for Cardiac Toxicity

The American Society of Clinical Oncology recommends performing comprehensive cardiovascular assessment including history, physical examination, and screening for cardiovascular risk factors before initiating potentially cardiotoxic therapies 1, 2
Baseline echocardiogram should be obtained prior to starting cardiotoxic treatments, especially for patients receiving high-dose anthracyclines or high-dose radiotherapy 1
Patients at high risk for cardiac dysfunction, including those receiving high-dose anthracyclines or high-dose radiotherapy, should be identified and monitored closely 1
Regular cardiac surveillance with echocardiography should be conducted for high-risk patients, and serum cardiac biomarkers or echocardiography-derived strain imaging should be considered 2
The American Society of Clinical Oncology recommends referring patients to cardiology based on concerning findings, and considering dexrazoxane, continuous infusion, or liposomal formulation of doxorubicin for patients receiving high-dose anthracyclines 1, 2

For colorectal cancer follow-up, the National Comprehensive Cancer Network recommends examinations every 6 months for 5 years for stage I, and every 3 months for 3 years, then every 6 months until 5 years for stage II-III 3
Each follow-up should include physical examination, blood CEA testing, liver ultrasound examination, and annual chest-abdomen-pelvis CT for stage III or if abnormal CEA/ultrasound 3
For ovarian cancer monitoring, patients receiving primary chemotherapy should be monitored with pelvic exams, CBC with platelets, chemistry profiles, CA-125 levels, and imaging studies as indicated 1, 3, 4

The National Comprehensive Cancer Network recommends that HIV status alone should not affect radiation therapy or surgical decisions, and potential drug-drug interactions between cancer therapies and antiretroviral medications should be monitored 5
For patients with dementia, decision-making capacity and related proxy powers should be reviewed, and reasonable adjustments to cancer care and treatment should be considered and implemented 6
The European Society of Cardiology recommends monitoring blood pressure before and periodically during treatment, and treating hypertension aggressively, especially with VEGF inhibitors 7, 8

The American Society of Clinical Oncology recommends avoiding or minimizing cardiotoxic therapies if established alternatives exist that won't compromise cancer outcomes, and collaborating closely with cardiology to determine whether to continue, modify, or discontinue cancer therapy 1, 2
For VEGF inhibitor-induced hypertension, dose reduction or reinforcement of antihypertensive treatment should be considered if blood pressure is not controlled 7, 8