Surveillance
Monitoring After Treatment
Recommendation 5.1
➤ Clinicians should complete a careful history and physical examination
in cancer survivors previously treated with potentially cardiotoxic
therapies. (Strong Recommendation; IC-B-Ins)
Recommendation 5.1.1
➤ In individuals with clinical signs or symptoms concerning for cardiac
dysfunction, the following approaches should be offered as part of
recommended care:
• Echocardiogram for diagnostic work-up (Strong Recommendation; EB-B-I)
• Cardiac MRI or 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) (Moderate
Recommendation; EB-B-I)
• Referral to a cardiologist based on findings (Strong Recommendation; IC-B-Ins)
Recommendation 5.2
➤ An echocardiogram may be performed 6–12 months after completion of
cancer-directed therapy in asymptomatic patients considered to be at
increased risk (See RISK) of cardiac dysfunction.
(Moderate Recommendation; EB-B-I)
Recommendation 5.2.1
➤ Cardiac MRI or MUGA may be offered for surveillance in asymptomatic
individuals if an echocardiogram is not available or technically feasible
(e.g. poor image quality), with preference given to cardiac MRI.
(Moderate Recommendation; EB-B-I)
Recommendation 5.3
➤ Patients identified to have asymptomatic cardiac dysfunction during
routine surveillance should be referred to a cardiologist or a healthcare
provider with cardio-oncology expertise for further assessment and
management. (Strong Recommendation; IC-B-Ins)
