title: The prevention, detection and management of cancer treatment-induced cardiotoxicity: a meta-review.
abstract: BACKGROUND
  The benefits associated with some cancer treatments do not come without risk. A serious side effect of some common cancer treatments is cardiotoxicity. Increased recognition of the public health implications of cancer treatment-induced cardiotoxicity has resulted in a proliferation of systematic reviews in this field to guide practice. Quality appraisal of these reviews is likely to limit the influence of biased conclusions from systematic reviews that have used poor methodology related to clinical decision-making. The aim of this meta-review is to appraise and synthesise evidence from only high quality systematic reviews focused on the prevention, detection or management of cancer treatment-induced cardiotoxicity.
  
  
  METHODS
  Using Cochrane methodology, we searched databases, citations and hand-searched bibliographies. Two reviewers independently appraised reviews and extracted findings. A total of 18 high quality systematic reviews were subsequently analysed, 67 % (n = 12) of these comprised meta-analyses.
  
  
  RESULTS
  One systematic review concluded that there is insufficient evidence regarding the utility of cardiac biomarkers for the detection of cardiotoxicity. The following strategies might reduce the risk of cardiotoxicity: 1) The concomitant administration of dexrazoxane with anthracylines; 2) The avoidance of anthracyclines where possible; 3) The continuous administration of anthracyclines (>6 h) rather than bolus dosing; and 4) The administration of anthracycline derivatives such as epirubicin or liposomal-encapsulated doxorubicin instead of doxorubicin. In terms of management, one review focused on medical interventions for treating anthracycline-induced cardiotoxicity during or after treatment of childhood cancer. Neither intervention (enalapril and phosphocreatine) was associated with statistically significant improvement in ejection fraction or mortality.
  
  
  CONCLUSIONS
  This review highlights the lack of high level evidence to guide clinical decision-making with respect to the detection and management of cancer treatment-associated cardiotoxicity. There is more evidence with respect to the prevention of this adverse effect of cancer treatment. This evidence, however, only applies to anthracycline-based chemotherapy in a predominantly adult population. There is no high-level evidence to guide clinical decision-making regarding the prevention, detection or management of radiation-induced cardiotoxicity.
authors.affiliation: School of Nursing, Institute of Health and Biomedical Innovation, Queensland University Technology, Kelvin Grove Campus, Kelvin Grove, QLD, 4059, Australia. aaron.conway@qut.edu.au.
authors.forename: Aaron
authors.initials: A
authors.lastname: Conway
authors.affiliation: Division of Cancer Services, Princess Alexandra Hospital and School of Nursing, Institute of Health and Biomedical Innovation, Queensland University Technology, Kelvin Grove Campus, Kelvin Grove, QLD, 4059, Australia. Al.mccarthy@qut.edu.au.
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: McCarthy
authors.affiliation: Nursing Research & Practice Development Unit The Prince Charles Hospital and School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, QLD, Australia. Petra.Lawrence@health.qld.gov.au.
authors.forename: Petra
authors.initials: P
authors.lastname: Lawrence
authors.affiliation: School of Nursing and Midwifery, Flinders University, 5042 GPO Box 2100, , Sturt Road, Bedford Park, Adelaide, 5001, South Australia. robyn.clark@flinders.edu.au.
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Clark
mesh_terms: D000818:Animals; D018943:Anthracyclines / Q000009:adverse effects / Q000627:therapeutic use; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use; D066126:Cardiotoxicity / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D016206:Databases, Bibliographic; D019468:Disease Management; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic