Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline
Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline
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DOI：
10.1200/jco.2016.70.5400
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发表时间：
2017-03-10
影响因子：
45.3
通讯作者：
Lenihan, Daniel
中科院分区：
文献类型：
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作者：
Armenian, Saro H.;Lacchetti, Christina;Lenihan, Daniel
心功能障碍是某些癌症导向治疗的严重不良反应，可干扰治疗效果，降低生活质量，或影响癌症患者的实际生存。这项工作的目的是为预防和监测成人起病癌症幸存者的心功能不全制定建议。方法建议由一个具有多学科代表性的专家小组制定，使用对荟萃分析、随机临床试验、观察性研究和临床经验的系统回顾(1996年至2016年)。根据研究设计，使用已建立的方法评估研究质量。指南建议部分是利用指南制定的决策支持方法。结果共有104项研究符合资格标准并构成建议的证据基础。这些指南中的建议的力度是基于证据的质量、数量和一致性以及益处和危害之间的平衡。建议对于卫生保健提供者来说，在开始治疗之前开始讨论风险足够高的个体发生心功能不全的可能性是很重要的。某些癌症幸存者的高危人群可能受益于在癌症导向治疗期间实施的预防和筛查策略。对于任何接受过潜在心脏毒性治疗的幸存者，临床上对心脏病的怀疑应该很高，心脏评估的门槛应该很低。对于某些癌症高危幸存者，在癌症指导治疗完成后，可能需要常规的心脏成像监测，以便可以启动适当的干预措施来阻止甚至逆转心脏功能障碍的进展。(C)2016年度美国临床肿瘤学会
PurposeCardiac 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.MethodsRecommendations 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.ResultsA 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.RecommendationsIt 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. (C) 2016 by American Society of Clinical Oncology