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
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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:
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Age of patient at time of treatment
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Total dose of anthracycline therapy
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Total dose of radiation to the chest
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Combination of anthracycline and radiation
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Amount of heart tissue included in radiation field
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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.
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Chemotherapy
Table 1
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Cardiomyopathy
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Arrhythmia
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CHF
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Pericarditis
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Pericardial Fibrosis
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Valvular
Disease
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Subclinical left ventricular dysfunction
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MI
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Atherosclerotic heart disease
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Alkylating Agents
Busulfan
Carmustine
BCNU
Chlorambucil
Cyclophosphamide
Cytoxan
Ifosphamide
Lomustine
CCNU
Mechlorethamine
Melphalan
Procarbazine
Thiotepa
Dacarbazine
DTIC
Temozolomide
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Heavy Metals
Cisplatin
Carboplatin
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Antimetabolites
Cytarabine
Ara-C
Mercaptopurine
6MP
Thioguanine
6TG
Methotrexate
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Anthracycline antibiotics
Daunorubicin
Doxorubicin
Adriamycin
Epirubicin
Idarubicin
Mitoxantrone
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X
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X
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X
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Chemotherapy
Table 2
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Cardiomyopathy
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Arrhythmia
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CHF
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Pericarditis
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Pericardial Fibrosis
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Valvular
Disease
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Subclinical left ventricular dysfunction
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MI
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Atherosclerotic heart disease
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Anti-tumor antibiotics
Bleomycin
Dactinomycin
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Corticosteroids
Dexamethasone
Decadron
Prednisone
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Enzymes
Asparaginase
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Plant alkaloids
Vincristine
Vinblastine
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Epipodophyllotoxins
Etoposide
VP16
Teniposide
VM26
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Radiation
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Cardiomyopathy
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Arrhythmia
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CHF
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Pericarditis
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Pericardial Fibrosis
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Valvular
Disease
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Subclinical left ventricular dysfunction
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MI
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Atherosclerotic heart disease
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All Radiation
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TBI
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X
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X
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X
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X
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X
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X
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X
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X
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Head/Brain
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Neck
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Thorax
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X
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X
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X
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X
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X
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X
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X
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X
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Abdomen
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X
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X
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X
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X
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X
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X
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X
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X
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Pelvis
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Extremity
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