title: Trastuzumab-induced cardiotoxicity.
abstract: OBJECTIVE
  To review trastuzumab-related cardiotoxic effects in the breast cancer adjuvant setting, present a system for pretreatment screening for cardiovascular risk factors, describe monitoring recommendations, provide a tool to facilitate adherence to monitoring guidelines, and discuss implications for patient education.
  
  
  METHODS
  Literature regarding cardiotoxicity and trastuzumab in breast cancer.
  
  
  RESULTS
  Trastuzumab was approved in 2006 for use in the adjuvant setting. A small percentage of women (approximately 4%) developed heart failure during or after treatment. However, the trials excluded women with cardiac disease. Current screening for cardiotoxicity relies on sequential left ventricular function measurements with either echocardiography or multigated acquisition scanning at baseline and every three months. Treatment modifications are recommended if changes from baseline are detected. Long-term and late effects have yet to be determined.
  
  
  CONCLUSIONS
  Although a small number of women experienced cardiotoxicity in the adjuvant setting, an increase may be seen because women with preexisting heart disease receive this treatment. Guidelines and tools will be helpful for appropriate and consistent screening of cardiac risk factors and disease prior to initiation of trastuzumab and for monitoring during and after administration.
  
  
  CONCLUSIONS
  Nurses are instrumental in assessing, monitoring, and treating women receiving trastuzumab. Implementing guidelines to promote adherence to recommended monitoring is important in the early detection of cardiotoxicity in this population. Educating women about their treatment and side effects is an important aspect of care.
authors.affiliation: Duke Health Systems, Duke Oncology Network, Durham, NC, USA. lisa.moss@duke.edu
authors.forename: Lisa Stegall
authors.initials: LS
authors.lastname: Moss
authors.forename: Mandy Fields
authors.initials: MF
authors.lastname: Starbuck
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
authors.forename: Elaine Brooks
authors.initials: EB
authors.lastname: Harwood
authors.forename: Jana
authors.initials: J
authors.lastname: Glotzer
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000451:nursing*; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000451:nursing*; D006801:Humans; D009859:Oncology Nursing; D012307:Risk Factors; D000068878:Trastuzumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab