Monitoring During Treatment
Recommendation 4.1
➤ Clinicians should complete a careful history and physical examination
in patients who are receiving potentially cardiotoxic treatments. (Strong
Recommendation; IC-B-Ins)
Recommendation 4.2
➤ In individuals with clinical signs or symptoms concerning for cardiac
dysfunction during routine clinical assessment, the following strategy is
recommended:
• Echocardiogram for diagnostic work-up (Strong Recommendation; EB-B-I)
• Cardiac magnetic resonance imaging (MRI) or multi-gated acquisition (MUGA) if
echocardiogram is not available or technically feasible (e.g. poor image quality), with
preference given to cardiac MRI (Moderate Recommendation; EB-B-I)
• Serum cardiac biomarkers (troponins, natriuretic peptides) or echocardiography-
derived strain imaging, in conjunction with routine diagnostic imaging
(Moderate Recommendation; EB-B-I)
• Referral to a cardiologist based on findings. (Strong Recommendation; IC-B-Ins)
Recommendation 4.3
➤ Routine surveillance imaging may be offered during treatment in
asymptomatic patients considered to be at increased risk (See RISK) of
developing cardiac dysfunction. In these individuals, echocardiography
is the surveillance imaging modality of choice that should be offered.
Frequency of surveillance should be determined by healthcare providers
based upon clinical judgment and patient circumstances.
(Moderate Recommendation; EB-B-I)
Recommendation 4.4
➤ No recommendations can be made regarding continuation/discontinuation
of cancer therapy in individuals with evidence of cardiac dysfunction.
This decision, made by the oncologist, should be informed by
close collaboration with a cardiologist, fully evaluating the clinical
circumstances, and considering the risks/benefits of continuation of
therapy responsible for the cardiac dysfunction. (IC-B-Ins)
Recommendation 4.5
➤ Clinicians may use routine echocardiographic surveillance in patients
with metastatic breast cancer continuing to receiving trastuzumab
indefinitely. The frequency of cardiac imaging for each patient should be
determined by healthcare providers, based upon clinical judgment and
patient circumstances. (Moderate Recommendation; EB/IC-B-L)
Surveillance
