The Dutch Childhood Oncology Group guideline for follow-up of asymptomatic cardiac dysfunction in childhood cancer survivors.
BACKGROUND
The Late Effects of Childhood Cancer task force of the Dutch Childhood Oncology Group (DCOG LATER) developed a guideline for follow-up of asymptomatic cardiac dysfunction in childhood cancer survivors (CCS). In this paper, we present the methods, available evidence and final recommendations of our guideline.


METHODS
A multidisciplinary working group specified clinical questions that should be answered to get to recommendations for the guideline. We carried out short or extensive evidence summaries and determined methodological quality of studies and levels of evidence in order to answer all clinical questions. When evidence was lacking for CCS, we carefully extrapolated evidence from other populations. Final recommendations were based on evidence and consensus.


RESULTS
There was high-level evidence for the increased risk of cardiac dysfunction in CCS and its main risk factors. Evidence was lacking regarding the prognosis, diagnosis and treatment of cardiac dysfunction in CCS. We recommended echocardiographic screening for asymptomatic cardiac dysfunction in CCS treated with cardiotoxic treatments and counseling about potential advantages and disadvantages of our screening recommendations.


CONCLUSIONS
The DCOG LATER guideline recommends risk-based screening for asymptomatic cardiac dysfunction in CCS, but it should be noted that recommendations are not completely supported by evidence in CCS.
Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam. Electronic address: e.sieswerda@amc.uva.nl.
E
E
Sieswerda
Department of Pediatric Oncology, Beatrix Children's Hospital, University Medical Center Groningen and University of Groningen, Groningen.
A
A
Postma
Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam.
E C
EC
van Dalen
Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam; Department of Medical Oncology, Academic Medical Center, Amsterdam.
H J H
HJH
van der Pal
Department of Pediatric Oncology, Beatrix Children's Hospital, University Medical Center Groningen and University of Groningen, Groningen.
W J E
WJE
Tissing
Department of Pediatric Cardiology, VU University Medical Center, Amsterdam.
L A J
LAJ
Rammeloo
Department of Cardiology, Academic Medical Center, Amsterdam.
W E M
WEM
Kok
Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
F E
FE
van Leeuwen
Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam.
H N
HN
Caron
Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam.
L C M
LCM
Kremer
D002648:Child; D004452:Echocardiography; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology*; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D009369:Neoplasms / Q000503:physiopathology*; D017741:Survivors