Chemotherapy‐related cardiotoxicity: are Australian practitioners missing the point?

Background It has long been established that cardiotoxicity occurs as a result of exposure to certain chemotherapeutics, particularly anthracyclines. Historically, clinicians equate cardiotoxicity with a poor prognosis, in a small percentage of patients and deem long‐term surveillance as optional. Emerging evidence suggests that anthracycline cardiotoxicity ( ACT ) is a life‐long risk with an incidence approaching 20%. Aims To elucidate the incidence of anthracycline cardiotoxicity within a current paediatric oncology survivor cohort. Methods Participants were identified through the Haematology‐Oncology database at the Royal Children's Hospital, Melbourne. Patients were identified from a retrospective audit of outpatient attendances between January 2008 and December 2015. Patients with a cancer diagnosis exposed to anthracyclines were eligible for the study. Patient demographics and echocardiogram findings were recorded with patients subcategorised according to degree of ACT . More significant ACT defined as fractional shortening ( FS ) <24% and less significant if FS 24–28% or a decline in baseline ejection fraction of >10%. Results Two hundred and eighty‐six of a total 481 identified patients were eligible for study inclusion. Twenty patients displayed significant ACT with FS <24%. Ten patients had a FS 24–28% and 25 patients with a decline in ejection fraction from baseline of >10%. Overall, 6.6% demonstrated significant cardiac complications, whilst 19.6 % demonstrated some degree of ACT and decline in myocardial function. When stratified for cumulative anthracycline dose, the incidence of severe cardiac dysfunction was 5.1% (<250 mg/m 2 ) and 25% (>250 mg/m 2 ) Conclusion This study demonstrates, in keeping with modern literature, the higher incidence of anthracycline associated cardiac toxicity and a need for better surveillance and follow up.