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Cardiac QuickFact

Childhood cancer survivors can be at risk for the following cardiac late effects:

  • Cardiomyopathy
  • Arrythmias
  • Congestive heart failure
  • Pericarditis
  • Pericardial fibrosis
  • Valvular disease
  • Subclinical left ventricular dysfunction (systolic dysfunction as assessed by ECHO or MUGA)
  • Myocardial infarction
  • Atherosclerotic heart disease

If your patient does not have a Survivor Health Plan (SHP), please refer him/her to the appropriate survivor clinic. 

 

Important factors in determining risk for cardiac late effects:

 

  • Age of patient at time of treatment
  • Total dose of anthracycline therapy
  • Total dose of radiation to the chest
  • Combination of anthracycline and radiation
  • Amount of heart tissue included in radiation field
  • Presence of other conditions affecting heart function

 

Generally, patients are at highest risk of developing cardiac late effects if treated with high doses of anthracyclines and radiation at a young age.

 

Chemotherapy

Table 1

Cardiomyopathy

Arrhythmia

CHF

Pericarditis

Pericardial Fibrosis

Valvular

Disease

Subclinical left ventricular dysfunction

MI

Atherosclerotic heart disease

Alkylating Agents                     

Busulfan

Carmustine

   BCNU  

Chlorambucil

Cyclophosphamide

   Cytoxan

Ifosphamide

Lomustine

   CCNU

Mechlorethamine Melphalan

Procarbazine

Thiotepa

Dacarbazine

   DTIC

Temozolomide

 

 

 

 

 

 

 

 

 

Heavy Metals

Cisplatin

Carboplatin

 

 

 

 

 

 

 

 

 

 

Antimetabolites

Cytarabine

   Ara-C

Mercaptopurine

   6MP

Thioguanine

   6TG

Methotrexate

 

 

 

 

 

 

 

 

 

 

Anthracycline antibiotics

Daunorubicin

Doxorubicin

   Adriamycin

Epirubicin

Idarubicin

Mitoxantrone

 

X

X

 

 

 

 

X

 

 

Chemotherapy

Table 2

Cardiomyopathy

Arrhythmia

CHF

Pericarditis

Pericardial Fibrosis

Valvular

Disease

Subclinical left ventricular dysfunction

MI

Atherosclerotic heart disease

Anti-tumor antibiotics

Bleomycin

Dactinomycin

 

 

 

 

 

 

 

 

 

 

Corticosteroids

Dexamethasone

   Decadron

Prednisone

 

 

 

 

 

 

 

 

 

 

Enzymes

Asparaginase

 

 

 

 

 

 

 

 

 

 

Plant alkaloids

Vincristine

Vinblastine

 

 

 

 

 

 

 

 

 

 

Epipodophyllotoxins

Etoposide

   VP16

Teniposide

   VM26

 

 

 

 

 

 

 

 

 

 

Radiation

Cardiomyopathy

Arrhythmia

CHF

Pericarditis

Pericardial Fibrosis

Valvular

Disease

Subclinical left ventricular dysfunction

MI

Atherosclerotic heart disease

All Radiation                 

 

 

 

 

 

 

 

 

 

TBI

X

X

X

X

X

X

 

X

X

Head/Brain

 

 

 

 

 

 

 

 

 

Neck

 

 

 

 

 

 

 

 

 

Thorax

X

X

X

X

X

X

 

X

X

Abdomen

X

X

X

X

X

X

 

X

X

Pelvis

 

 

 

 

 

 

 

 

 

 

Extremity

 

 

 

 

 

 

 

 

 

 

For recommendations on how to screen for all potential late effects, please refer to The Children's Oncology Group Long-Term Follow-Up Guidelines.

 

Health Links - Teaching Handouts from The Children's Oncology Group

Heart Health

Cardiovascular Risk Factors

Diet and Physical Activity

 

Visit www.survivorshipguidelines.org  to find many of the Health Links translated into other languages.  


References:

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links Version 4.0. October, 2013. http://www.survivorshipguidelines.org/.

 

Shankar, S., Marina, N., Hudson, M., Hodgson, D., Adams, M., Landier, W., Bhatia, S., Meeske, K., Chen, M., Kinahan, K., Steinberger, J., and Rosenthal, D.  Monitoring for Cardiovascular Disease in Survivors of Childhood Cancer: Report from the Cardiovascular Disease Task Force of the Children’s Oncology Group.  Pediatrics, 2008. 121: e387-e396.

 

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 1/30/2015 4:07:47 PM
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