title: Canadian Cardiovascular Society Guidelines for Evaluation and Management of Cardiovascular Complications of Cancer Therapy.
abstract: Modern treatment strategies have led to improvements in cancer survival, however, these gains might be offset by the potential negative effect of cancer therapy on cardiovascular health. Cardiotoxicity is now recognized as a leading cause of long-term morbidity and mortality among cancer survivors. This guideline, authored by a pan-Canadian expert group of health care providers and commissioned by the Canadian Cardiovascular Society, is intended to guide the care of cancer patients with established cardiovascular disease or those at risk of experiencing toxicities related to cancer treatment. It includes recommendations and important management considerations with a focus on 4 main areas: identification of the high-risk population for cardiotoxicity, detection and prevention of cardiotoxicity, treatment of cardiotoxicity, and a multidisciplinary approach to cardio-oncology. All recommendations align with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Key recommendations for which the panel provides a strong level of evidence include: (1) that routine evaluation of traditional cardiovascular risk factors and optimal treatment of preexisting cardiovascular disease be performed in all patients before, during, and after receiving cancer therapy; (2) that initiation, maintenance, and/or augmentation of antihypertensive therapy be instituted per the Canadian Hypertension Educational Program guidelines for patients with preexisting hypertension or for those who experience hypertension related to cancer therapy; and (3) that investigation and management follow current Canadian Cardiovascular Society heart failure guidelines for cancer patients who develop clinical heart failure or an asymptomatic decline in left ventricular ejection fraction during or after cancer treatment. This guideline provides guidance to clinicians on contemporary best practices for the cardiovascular care of cancer patients.
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: svirani@telus.net.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Virani
authors.affiliation: The Ottawa Hospital Cancer Center, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Dent
authors.affiliation: St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Brezden-Masley
authors.affiliation: Libin Cardiovascular Institute, Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Clarke
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Margot K
authors.initials: MK
authors.lastname: Davis
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Davinder S
authors.initials: DS
authors.lastname: Jassal
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Johnson
authors.affiliation: Centre de recherche sur le cancer du CHU de Québec and Centre hospitalier universitaire de Québec (CHU de Québec), Québec, Québec, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Lemieux
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Paterson
authors.affiliation: Jewish General Hospital, McGill University, Montréal, Québec, Canada.
authors.forename: Igal A
authors.initials: IA
authors.lastname: Sebag
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Simmons
authors.affiliation: The Ottawa Hospital Cancer Center, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sulpher
authors.affiliation: Queen's University, Kingston, Ontario, Canada.
authors.forename: Kishore
authors.initials: K
authors.lastname: Thain
authors.affiliation: Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paaldinesh
authors.initials: P
authors.lastname: Thavendiranathan
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Wentzell
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Nola
authors.initials: N
authors.lastname: Wurtele
authors.affiliation: Laval University, CHU de Québec, Québec, Québec, Canada.
authors.forename: Marc André
authors.initials: MA
authors.lastname: Côté
authors.affiliation: Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
authors.forename: Nowell M
authors.initials: NM
authors.lastname: Fine
authors.affiliation: University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Haissam
authors.initials: H
authors.lastname: Haddad
authors.affiliation: Memorial University, St John's, Newfoundland, Canada.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Hayley
authors.affiliation: Royal Victoria Regional Health Centre, Barrie, Ontario, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: Hopkins
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Anil A
authors.initials: AA
authors.lastname: Joy
authors.affiliation: Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rayson
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Ellamae
authors.initials: E
authors.lastname: Stadnick
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: Straatman
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002316:Cardiotonic Agents / Q000627:therapeutic use; D066126:Cardiotoxicity / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D054715:Cardiotoxins / Q000009:adverse effects; D003328:Coronary Thrombosis / Q000209:etiology / Q000628:therapy; D042241:Early Diagnosis; D019560:Echocardiography, Three-Dimensional; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000628:therapy; D019028:Magnetic Resonance Imaging, Cine; D017202:Myocardial Ischemia / Q000209:etiology / Q000628:therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009369:Neoplasms / Q000628:therapy; D011322:Primary Prevention; D011878:Radiotherapy / Q000009:adverse effects*; D012307:Risk Factors; D020107:Troponin T / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D002316:Cardiotonic Agents; D054715:Cardiotoxins; D020107:Troponin T; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein