Cancer therapy-induced cardiotoxicity: Review and algorithmic approach toward evaluation

In pediatric cancer, the overall 5-year survival has increased to more than 80%, but these improvements in cancer outcomes have come at the cost of increased morbidity and mortality. These can occur during or early after treatment, and in others may occur many years after cancer treatment is completed. Survivors of childhood cancers are at an increased risk of developing congestive heart failure and premature death due to cardiac causes (coronary artery disease, stroke, and congestive heart failure). There is a strong dose-dependent relationship between anthracycline chemotherapy exposure and risk of congestive heart failure, and the risk is increased in those who have been exposed to chest radiation. Early detection of myocardial injury, prevention of myocardial dysfunction, strategies to promote quick recovery of myocardial function in case of injury, and monitoring for delayed effects of cancer therapy are areas which both oncologists as well as cardiologists looking after cancer patients need to understand. A subspecialty of cardio-oncology has emerged to allow more focus in these areas.