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FEATURE ARTICLE
Cardiac Toxicity Related
to Cancer Treatment
Victoria Wochna Loerzel, MSN, RN, OCN ®, and Karen Hassey Dow, PhD, RN, FAAN
treatment that damage myoardiac toxicity is a dosecytes (cells of the myocarlimiting toxicity that
Cardiac toxicity is a dose-limiting toxicity that may occur
dium). This damage leads to
may occur during treatduring cancer treatment or several years after therapy
loss of myocardial contractility
ment or as a late effect of therends. Cardiac toxicity may be caused by chemotherapy,
and eventual cell death (Hochapy. Chemotherapy, radiation
biotherapy, and radiation therapy and may result in carster, Wasserheit, & Speyer,
therapy (RT), biotherapy, and
1995; Shan, Lincoff, & Young,
targeted therapy contribute to
diomyopathy, congestive heart failure, dysrhythmias, and
1996; Speyer & Freedberg,
cardiovascular compromise
myocardial ischemia. The risk for developing cardiac tox2000). Recent evidence indithat can result in cardiomyopaicity varies based on type of treatment, patient age, prescates that oxidative stress and
thy, congestive heart failure
mitochondrial dysfunction also
ence of preexisting or concurrent heart disease, and con(CHF), dysrhythmias, and
may be key factors in the pathomyocardial ischemia. Adcomitant treatment. Patients at high risk require careful
genic process (Santos, Moreno,
vances in treatment using limevaluation and monitoring during and in the years followLeino, Froberg, & Wallace,
ited multiagent chemotherapy
ing therapy to detect cardiac changes. Fortunately,
2002).
and reduced volume of radiaAlthough acute anthracytion treatment to the heart concardioprotective agents and newer radiation therapy
cline-induced toxicity is rare
tribute to minimizing late cartechniques decrease the risk for treatment-related car(Shan et al., 1996), chronic condiac toxicity. However, cardiac
diac toxicity. Oncology nurses can become more inditions such as cardiomyopathy
toxicity remains a cause of maformed in the assessment of cardiac toxicity and can arm
and CHF may develop over time
jor morbidity and mortality
and may be severe. Thomas, Le,
among childhood, adolescent,
themselves with knowledge about early identification of
and Fiere (2002) described three
and some adult cancer survisymptoms as well as specific agents and treatments that
long-term survivors of acute
vors (Chronowski et al., 2003;
increase risk for cardiac toxicity.
promyelocytic leukemia who deDonaldson, Hancock, &
veloped anthracycline-induced
Hoppe, 1999; Mertens et al.,
Key Words: cardiotoxin, anthracyclines, radiotherapy
CHF that required cardiac trans2001).
plantation.
Data from the Childhood
Doxorubicin has been the most widely
Cancer Survivors Study indicate that childChemotherapy-Induced
studied cardiotoxic agent in adult and pedihood and adolescent cancer survivors who
Cardiac Toxicity
atric patients. Daunorubicin, an agent prilived more than five years after treatment
marily used in treating acute leukemia, has
were 8.8 times more likely to die from carAnthracyclines, alkylating agents, 5-fluo- a cardiotoxic risk profile similar to doxorudiac-related events (Mertens et al., 2001).
Adults who receive high-dose chemotherapy rouracil (5-FU), and paclitaxel are the drugs bicin. However, epirubicin and idarubicin,
for breast cancer or lymphoma and standard most often associated with cardiac toxicity. analogs similar to doxorubicin, are associtreatment for non-small cell lung cancer, as These agents are associated with cardiomy- ated with cardiac toxicity to a lesser degree
well as women who receive treatment for ad- opathy, CHF, dysrhythmias, and myocardial than doxorubicin.
vanced breast cancer, also may experience ischemia.
cardiac dysfunction following treatment.
Submitted March 2003. Accepted for publicaGiven the growing number of long-term Anthracyclines
tion April 4, 2003. (Mention of specific prodcancer survivors, nurses must be informed
ucts and opinions related to those products
Anthracyclines are used to treat a variabout the potential for treatment-induced
do not indicate or imply endorsement by the
cardiotoxicity. This article reviews car- ety of cancers and are the agents most
Clinical Journal of Oncology Nursing or the
diotoxic treatments, signs and symptoms of widely associated with irreversible cardioOncology Nursing Society.)
cardiotoxicity, cardioprotective measures, myopathy. Cardiotoxicity is thought to result from the release of free radicals during Digital Object Identifier: 10.1188/03.CJON.557-562
and clinical implications.
C
CLINICAL JOURNAL OF ONCOLOGY NURSING • VOLUME 7, NUMBER 5 • CARDIAC TOXICITY RELATED TO CANCER TREATMENT
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