The prevention, detection and management of cancer treatment-induced cardiotoxicity: a meta-review

BMC Cancer

Research Article

Alexandra L McCarthy¹  Petra Lawrence²  Robyn A Clark³  Aaron Conway⁴ 

[1] Division of Cancer Services, Princess Alexandra Hospital and School of Nursing, Institute of Health and Biomedical Innovation, Queensland University Technology, Kelvin Grove Campus, 4059, Kelvin Grove, QLD, Australia;Nursing Research & Practice Development Unit The Prince Charles Hospital and School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, QLD, Australia;School of Nursing and Midwifery, Flinders University, 5042 GPO Box 2100,, Sturt Road, Bedford Park, 5001, Adelaide, South Australia;School of Nursing, Institute of Health and Biomedical Innovation, Queensland University Technology, Kelvin Grove Campus, 4059, Kelvin Grove, QLD, Australia;

关键词: Heart failure;    Chemotherapy;    Cardiotoxicity;    Cancer;    Systematic review;    Meta-review;   

DOI  :  10.1186/s12885-015-1407-6

 received in 2014-09-17, accepted in 2015-04-29,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsUsing 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.ResultsOne 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.ConclusionThis 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.

【 授权许可】

Unknown   
© Conway et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.