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Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Health Professional Information [NCI] - Late Effects of the Cardiovascular System

Table 2. Cardiovascular Late Effects

Predisposing TherapyPotential Cardiovascular EffectsHealth Screening
DOE = dyspnea on exertion; SOB = shortness of breath.
Anthracyclines (daunorubicin, doxorubicin, idarubicin, epirubicin); mitoxantroneCardiomyopathy; arrhythmias; subclinical left ventricular dysfunctionHistory: SOB, DOE, orthopnea, chest pain, palpitations
Cardiovascular exam
Echocardiogram or other modality to evaluate left ventricular systolic function
Electrocardiogram
Laboratory: lipid profile, consider troponin or brain natriuretic peptide (BNP) level
Radiation impacting the heartCongestive heart failure; cardiomyopathy; pericarditis/pericardial fibrosis; valvular disease; atherosclerotic heart disease/myocardial infarction; arrhythmiaHistory: SOB, DOE, orthopnea, chest pain, palpitations
Cardiovascular exam: signs of heart failure, arrhythmia, valve dysfunction
Echocardiogram or other modality to evaluate left ventricular systolic function
Electrocardiogram
Laboratory: lipid profile
Radiation impacting vascular structuresCarotid or subclavian artery diseaseHistory: transient/permanent neurological events
Blood pressure
Cardiovascular exam: peripheral pulses, presence of bruits
Neurological exam
Carotid ultrasound
Laboratory: lipid profile
Plant alkaloids (vinblastine, vincristine)Vasospastic attacks (Raynaud's phenomena); autonomic dysfunction (e.g., monotonous pulse)History: vasospasms of hands, feet, nose, lips, cheeks, or earlobes related to stress or cold temperatures
Exam of affected area
Electrocardiogram
Platinum agents (cisplatin, carboplatin)DyslipidemiaFasting lipid profile

In general, survivors should be counseled regarding the cardiovascular benefits of maintaining healthy weight, adhering to a heart-healthy diet, participating in regular physical activity, and abstaining from smoking. Survivors should obtain medical clearance before engaging in extreme exercise programs. Clinicians should consider baseline and follow-up screening as needed for comorbid conditions that impact cardiovascular health.

Refer to the Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers for cardiovascular late effects information including risk factors, evaluation, and health counseling.

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Last Updated: February 25, 2014
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