Table 2 The cardio-oncology surveillance guide, which outlines the cardiac surveillance and prevention protocols for both inpatient and outpatient settings. Shown here is a part of a comprehensive cardio-oncology protocol that was developed based on the most updated practice guidelines. Please note that the complete version of the protocol is not shown here

High Risk for Cardiotoxicity

 * Age > 60

 * (> = 2) PMH: HTN, HLD, DM, CKD2, FH of cardiomyopathy/premature CAD

 * (> = 2) PSH: Smoking, alcoholism, obesity, sedentary lifestyle

 * Cardiac: pre-existing CAD, arrhythmia or structural heart disease

 * Prior exposure: >  = 250 mg/m2 cumulative doxorubicin dose or equivalent

 * Prior exposure: prior chest/mediastinum RT

 * Prior exposure: Sequential anthracyclines + trastuzumab

 * Timing of exposure: childhood cancer survivors with exposure

Indications for Cardio-Oncology Consultation

 Outpatient:

  • Cancer therapy related cardiac dysfunction (CTRCD)

  • Asymptomatic cardiac abnormality with cancer therapy

  • Primary prevention in patients with CV toxicity risk factors

  • Secondary prevention for chemo-induced cardiotoxicity

  • Cancer patients or survivors with concurrent cardiovascular disease

  • Pre-clinical trial cardiac optimization for cardiotoxic trial agents

  • Cancer with cardiac involvement

  • Infiltrative heart disease, e.g. Cardiac Amyloidosis

  • Childhood cancer survivors

 Inpatient:

  o Any active cardiac issues in the setting of active/recent/planned cancer therapeutics or recent diagnosis of cancer

  o No active cardiac issues but starting new chemotherapy with history of cardio-toxicity/ cardiomyopathy/cardiovascular disease/high risk as stated above

Surveillance and Monitoring Protocol after treatment in patients at risk for CTRCD (for anthracycline or trastuzumab)

 - Pre-Treatment for all patients on anthracycline or trastuzumab

 - During Anthracycline Treatment: at completion of therapy and 6 months later if < 240 mg/m2, or prior to treatment of each additional 50 mg/m2 if reach or exceeding 240 mg/m2. 6 months after Anthracycline Treatment: At the discretion of cardiologist & oncologist

 - During Trastuzumab Treatment: Every 3—6 months (based on patient risk factors)

 - After Trastuzumab Treatment: Every 6 months for two years post-treatment, and then at the discretion of cardiologist & oncologist after two years

To be continued.