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Canadian Journal of Cardiology

Canadian Cardiovascular Society Guidelines for Evaluation and Management of Cardiovascular Complications of Cancer Therapy

Published:April 07, 2016DOI:https://doi.org/10.1016/j.cjca.2016.02.078

      Abstract

      Modern treatment strategies have led to improvements in cancer survival, however, these gains might be offset by the potential negative effect of cancer therapy on cardiovascular health. Cardiotoxicity is now recognized as a leading cause of long-term morbidity and mortality among cancer survivors. This guideline, authored by a pan-Canadian expert group of health care providers and commissioned by the Canadian Cardiovascular Society, is intended to guide the care of cancer patients with established cardiovascular disease or those at risk of experiencing toxicities related to cancer treatment. It includes recommendations and important management considerations with a focus on 4 main areas: identification of the high-risk population for cardiotoxicity, detection and prevention of cardiotoxicity, treatment of cardiotoxicity, and a multidisciplinary approach to cardio-oncology. All recommendations align with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Key recommendations for which the panel provides a strong level of evidence include: (1) that routine evaluation of traditional cardiovascular risk factors and optimal treatment of preexisting cardiovascular disease be performed in all patients before, during, and after receiving cancer therapy; (2) that initiation, maintenance, and/or augmentation of antihypertensive therapy be instituted per the Canadian Hypertension Educational Program guidelines for patients with preexisting hypertension or for those who experience hypertension related to cancer therapy; and (3) that investigation and management follow current Canadian Cardiovascular Society heart failure guidelines for cancer patients who develop clinical heart failure or an asymptomatic decline in left ventricular ejection fraction during or after cancer treatment. This guideline provides guidance to clinicians on contemporary best practices for the cardiovascular care of cancer patients.

      Résumé

      Les stratégies modernes de traitement du cancer ont permis d’améliorer le taux de survie, mais ce gain pourrait être contrecarré par les possibles effets négatifs du traitement anticancéreux sur la santé cardiovasculaire. En effet, il est maintenant reconnu que la cardiotoxicité liée au traitement anticancéreux constitue la principale cause de morbidité et de mortalité à long terme chez les survivants du cancer. Ces lignes directrices, dont l’élaboration par un groupe pancanadien d’experts en soins de santé a été mandatée par la Société canadienne de cardiologie, ont pour but d’orienter le traitement des patients cancéreux atteints d’une maladie cardiovasculaire établie ou à risque de subir des effets toxiques liés au traitement anticancéreux. On y trouve des recommandations et d’importantes considérations pour la prise en charge des patients qui ont été réparties en quatre volets distincts, soit la reconnaissance de la population à risque élevé de cardiotoxicité, le dépistage et la prévention de la cardiotoxicité, le traitement de la cardiotoxicité et l’approche multidisciplinaire de la cardio-oncologie. Toutes les recommandations contenues dans les lignes directrices sont conformes aux critères du système GRADE (Grading of Recommendations Assessment, Development, and Evaluation system). Les principales recommandations auxquelles le groupe d’experts a accordé un niveau de preuve élevé sont les suivantes : 1) l’évaluation systématique des facteurs de risque cardiovasculaire traditionnels de même que le traitement optimal d’une cardiopathie préexistante doivent être effectués chez tous les patients avant, pendant et après le traitement anticancéreux; 2) le traitement antihypertenseur doit être instauré, poursuivi et/ou ajusté conformément aux lignes directrices du Programme éducatif canadien sur l’hypertension, chez les patients souffrant déjà d’hypertension ou chez ceux qui développent ce problème au cours du traitement anticancéreux; et 3) les patients cancéreux qui présentent une insuffisance cardiaque clinique ou un déclin asymptomatique de leur fraction d’éjection ventriculaire gauche au cours du traitement anticancéreux ou après ce dernier doivent être évalués et pris en charge conformément aux lignes directrices actuelles sur le traitement de l’insuffisance cardiaque de la Société canadienne de cardiologie. Ces lignes directrices ont pour objectif de faire connaître aux professionnels de la santé les meilleures pratiques actuelles en matière de soins cardiovasculaires destinés aux patients atteints de cancer.
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