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

Journal article


Conway, Aaron, McCarthy, Alexandra L., Lawrence, Petra and Clark, Robyn A.. (2015). The prevention, detection and management of cancer treatment-induced cardiotoxicity : A meta-review. BMC Cancer. 15(1), p. 366. https://doi.org/10.1186/s12885-015-1407-6
AuthorsConway, Aaron, McCarthy, Alexandra L., Lawrence, Petra and Clark, Robyn A.
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.

Conclusion
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.

Keywordsheart failure; chemotherapy; cardiotoxicity; cancer; systematic review; meta-review
Year2015
JournalBMC Cancer
Journal citation15 (1), p. 366
PublisherBioMed Central
ISSN1471-2407
Digital Object Identifier (DOI)https://doi.org/10.1186/s12885-015-1407-6
Scopus EID2-s2.0-84929159079
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-16
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online07 May 2015
Publication process dates
Accepted29 Apr 2015
Deposited18 May 2021
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