Approaches for monitoring and treating cardiomyopathy among cancer survivors following anthracycline or thoracic radiation treatment

Arash Delavar; Catherine Boutros; Dana Barnea; Wendy L Schaffer; Emily S Tonorezos

doi:10.1186/s40959-022-00138-x

Approaches for monitoring and treating cardiomyopathy among cancer survivors following anthracycline or thoracic radiation treatment

Cardiooncology. 2022 May 12;8(1):11. doi: 10.1186/s40959-022-00138-x.

Authors

Arash Delavar^{1

2}, Catherine Boutros^{1

3}, Dana Barnea⁴, Wendy L Schaffer¹, Emily S Tonorezos^{5

6}

Affiliations

¹ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
² University of California San Diego School of Medicine, La Jolla, CA, San Diego, USA.
³ City University of New York School of Medicine, New York, NY, USA.
⁴ Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
⁵ Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA. Emily.tonorezos@Nih.gov.
⁶ Office of Cancer Survivorship, National Cancer Institute, 9409 Medical Center Drive, Rockville, MD, 20850, USA. Emily.tonorezos@Nih.gov.

Abstract

Background: Anthracycline chemotherapy and thoracic radiation therapy (RT) are known causes of cardiomyopathy among cancer survivors, however, management guidelines for this population are lacking. In this study we describe our single institution management approach for cancer survivors with low left ventricular ejection fraction (LVEF) secondary to cancer treatment.

Methods: We conducted a retrospective descriptive study of childhood and young adult (CAYA) cancer survivors in the Adult Long-Term Follow-Up Clinic at Memorial Sloan Kettering Cancer Center enrolled between November 2005 and July 2019. Those included were treated with anthracycline and/or thoracic RT as a part of their cancer therapy and had recorded a LVEF of < 55% on at least one post-treatment echocardiogram. Details regarding survivor characteristics, screening, and management were abstracted. Differences in management approaches among survivors with LVEF of 50-54.9%, 40-49.9%, and < 40% were described. Qualitative management approaches were abstracted as well.

Results: Among 668 CAYA survivors in the initial cohort, 80 were identified who had received anthracycline and/or thoracic RT and had a LVEF of < 55%. Median age at cancer diagnosis was 16.1 years, median time from cancer diagnosis was 25.8 years, and 55% of survivors were female. Cardiology referrals, nuclear stress tests, multi-gated acquisition scans, angiograms, echocardiograms, treatment with angiotensin converting enzyme inhibitors or receptor blockers, beta-blockers, diuretics, aldosterone antagonists, aspirin, and insertion of pacemaker or implantable cardioverter-defibrillators differed by LVEF category. Documentation suggested uncertainty regarding management of survivors with borderline low-LVEF, with low-LVEF that improved on follow-up, and with subsequent cancers requiring additional treatment.

Conclusions: The management of CAYA cancer survivors with low-LVEF largely followed guidelines designed for the general population, however, uncertainty remains for issues specific to cancer survivors. Cardiomyopathy management guidelines that address issues specific to cancer survivors are needed.

Keywords: Anthracycline; Cancer survivorship; Cardiomyopathy; Medical decision making; Preventive cardiology; Radiation therapy.

Abstract

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