anthracyclines and become cancer survivors, it is
clear that there is no ‘‘safe dose’’ free from
potential cardiovascular damage. Cumulative dose
and length of follow-up after anthracycline expo-
sure both effect the development of late cardio-
toxicity; in group analyses, cardiotoxicity in long
term survivors is progressive regardless of dose.
Survivors should be counselled about the presence
of cardiac risk, encouraged to follow a preventive
heart healthy lifestyle, and monitored lifelong with
appropriate tests to identify subclinical cardiovas-
cular disease. With regard to preserving cardiac
function without compromising anti-tumour effi-
cacy, recent clinical data from paediatric and adult
oncology trials support the use of dexrazoxane
during treatment on research protocols. With the
increased success of paediatric cancer treatment,
cardiac care providers must assume their role in the
prevention, diagnosis, and management of treat-
ment related cardiovascular disease.
Acknowledgements: Our thanks to Drs Rudolf Steiner, Eugene
Herman, and James Speyer for their review and editorial insight.
Funding: This paper has been supported in part by grants from the
National Cancer Institute (CA68484-SL, CA34183-SL, CA79060-SL,
CA06516-SL, CA127642-SL), National Heart, Lung, and Blood
Institute (HL69800-SL, HL53392-SL, HL59837-SL, HL53392-SL), the
Lance Armstrong Foundation (SL), the Children’s Cardiomyopathy
Foundation (SL), and the Women’s Cancer Association (SL).
Competing interests: In compliance with EBAC/EACCME guide-
lines, all authors participating in Education in Heart have disclosed
potential conflicts of interest that might cause a bias in the article. Dr
Lipshultz has investigator-initiated research grants from Pfizer and
Novartis and has been a consultant to Chiron, all of whom
manufacture dexrazoxane. The other authors indicated no potential
financial conflicts of interest.
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Education in Heart
532 Heart 2008;94:525–533. doi:10.1136/hrt.2007.136093