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      Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline.

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          Abstract

          Purpose Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers. Methods Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review (1996 to 2016) of meta-analyses, randomized clinical trials, observational studies, and clinical experience. Study quality was assessed using established methods, per study design. The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology. Results A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. Recommendations It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy. Certain higher risk populations of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies. Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy. For certain higher risk survivors of cancer, routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy, so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction.

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          Author and article information

          Journal
          J. Clin. Oncol.
          Journal of clinical oncology : official journal of the American Society of Clinical Oncology
          American Society of Clinical Oncology (ASCO)
          1527-7755
          0732-183X
          Mar 10 2017
          : 35
          : 8
          Affiliations
          [1 ] Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; Susan Dent, The Ottawa Hospital Cancer Center, Ottawa, Ontario, Canada; Pamela S. Douglas, Duke University, Durham, NC; Jean-Bernard Durand and Michael Ewer, The University of Texas MD Anderson Cancer Center, Houston, TX; Carol Fabian, University of Kansas Medical Center, Kansas City, KS; Melissa Hudson, St Jude Children's Research Hospital, Memphis; Javid Moslehi and Daniel Lenihan, Vanderbilt University; Katharine Ray, Patient Representative, Nashville, TN; Erica L. Mayer, Dana-Farber Cancer Institute, Boston, MA; and Kathryn Ruddy, Mayo Clinic, Rochester, MN.
          Article
          10.1200/JCO.2016.70.5400
          10.1200/JCO.2016.70.5400
          27918725

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