Cardiotoxicity in Cancer Patients: A Study Based on a Review of Electronic Medical Records from a Reference Center
Cardiotoxicity in Cancer Patients
DOI:
https://doi.org/10.36557/2674-8169.2026v8n4p864-882Keywords:
Medical Record, Cardiotoxicity, Cancer, PatientAbstract
Introduction: In order for cardiotoxicity in cancer patients to be detected, prevented, or mitigated, it is essential that all patients undergo a rigorous initial cardiovascular assessment and close monitoring, according to specific protocols in the field and the healthcare institution's record forms. The Patient Record is considered a relevant document for recording information about the individual's care pathway in healthcare units.
Objective: To present the epidemiological and clinical aspects related to cardiotoxicity in cancer patients undergoing chemotherapy treatment with doxorubicin, through a review of the electronic medical records of a reference cancer hospital.
Methods: Cohort, longitudinal, retrospective, non-interventional study. The records in electronic and/or physical medical records of patients treated with doxorubicin, with hematological cancer (acute myeloid leukemia or non-Hodgkin lymphoma) or breast cancer, were analyzed for the period between January 2015 and July 2020.
Results: The total sample of this study consisted of 172 medical records of patients with cancer, with 132 (77%) having breast cancer and 40 (23%) having non-Hodgkin lymphoma. Regarding gender/sex, 70 (41%) were male and 102 (59%) female. An average of 125 (38.2) medical records did not have information on the patients' risk factors, and the absence of comorbidity records was 129.8 (29.5) medical records. Laboratory data were not recorded in 131.7 (56.3) patient records, data regarding clinical signs were missing in 166 (2.6) patients, and diagnostic tests were not recorded in 115.5 (37.1) records.
Conclusion: It is understood that the lack of information in the records, such as: sociodemographic data, aspects of cancer treatment and other evolutionary data, represented a difficulty in data collection and development of this research.
Downloads
References
Ewer MS, Ewer SM. Cardiotoxicity of anticancer treatments: what the cardiologist needs to know. Nat Rev Cardiol. 2010;7(10):564-75. doi: 10.1038/nrcardio.2010.121
Wu XZ. Origin of cancer stem cells: the role of self-renewal and differentiation. Ann Surg Oncol. 2008;15:407-14. https://doi.org/10.1245/s10434-007-9695-y
Monsuez JJ, Charniot JC, Vignat N, Artigou JY. Cardiac side-effects of cancer chemotherapy. Int J Cardiol. 2010;144(1):3-15. doi: 10.1016/j.ijcard.2010.03.003.
Geiger S, Lange V, Suhl P, Heinemann V, Stemmler HJ. Anticancer therapy induced cardiotoxicity: review of the literature. Anticancer Drugs 2010;21(6):578-90. DOI: 10.1097/CAD.0b013e3283394624
Piveta RB, Fischer CH. Métodos Diagnósticos em Cardio-Oncologia. Rev Soc Cardiol Estado de São Paulo 2017;27(4):307-12. http://dx.doi.org/10.29381/0103-8559/20172704307-12
Hajjar LA. et al. Diretriz Brasileira de Cardio-oncologia – 2020. Arq Bras Cardiol. 2020;115(5):1006-1043. https://doi.org/10.36660/abc.20201006
Wassmuth R. et al. Subclinical cardiotoxic effects of anthracyclines as assessed by magnetic resonance imaging-a pilot study. Am Hear J. 2001;141(6):1007-13. DOI: 10.1067/mhj.2001.115436
Armstrong GT. et al. Screening adult survivors of childhood cancer for cardiomyopathy: Comparison of echocardiography and cardiac magnetic resonance imaging. J Clin Oncol. 2012;30(23):2876-84. DOI: 10.1200/JCO.2011.40.3584
Malta M, Cardoso LO, Bastos FI, Magnanini M FS. CMFP da. Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Rev Saúde Pública 2010;44(3):559–65. https://doi.org/10.1590/S0034-89102010000300021
Abdel-Qadir H, Thavendiranathan P, Austin PC, Lee DS, Amir E, Tu JV, et al. Development and validation of a multivariable prediction model for major adverse cardiovascular events after early stage breast cancer: a population-based cohort study. Eur Heart J. 2019;40(48):3913-20. doi: 10.1093/eurheartj/ehz460
Instituto Nacional de Câncer. Estimativa 2020. Disponível em <https://www.inca.gov.br/estimativa/sintese-de-resultados-e-comentarios> Acessado [15 jul 2021].
Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F. Global Cancer Obser-Vatory: Cancer Today. International Agency for Research on Cancer: Lyon, France, 2020.
Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J. Clin. 2014;64:9-29. DOI: 10.3322/caac.21208
McGuire A, Brown JAL, Malone C, McLaughlin R, Kerin MJ. Effects of Age on the Detection and Management of Breast Cancer. Cancers 2015;7:908-929. doi: 10.3390/cancers7020815
Hill DA, Prossnitz ER, Royce M, Nibbe A. Temporal trends in breast cancer survival by race and ethnicity: A population-based cohort study. PLoS ONE 2019;14:e0224064. doi: 10.1371/journal.pone.0224064.
Yedjou CG, Sims JN, Miele L, Noubissi F, Lowe L, Fonseca DD, et al. Health and Racial Disparity in Breast Cancer. Adv. Exp. Med. Biol. 2019;1152:31-49. doi: 10.1007/978-3-030-20301-6_3
American Cancer Society. Breast Cancer Facts & Figures, 2015–2016; American Cancer Society: Atlanta, GA, USA, 2016.
World Health Organization. Obesity: preventing and managing the global epidemic. Report of a World Health Organization Consultation. Geneva: World Health Organization, 2000. p. 256. WHO Obesity Technical Report Series, n. 284.
Wang X, Hui TL, Wang MQ, Liu H, Li RY, Song ZC. Body Mass Index at Diagnosis as a Prognostic Factor for Early-Stage Invasive Breast Cancer after Surgical Resection. Oncol Res Treat. 2019;42(4):195-201. doi: 10.1159/000496548.
Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010;123(3):627-35. doi: 10.1007/s10549-010-0990-0.
Instituto Nacional de Câncer. Estimativa 2018. Disponível em <http://www2.inca.gov.br/wps/wcm/connect/comunicacaoinformacao/site/home/sala_imprensa/releases/2018/inca-estima-havera-cerca-600-mil-novos-casos-cancer-2018> Acessado [ 15 jul 2019].
Herrmann J, Lerman A, Sandhu NP, Villarraga HR, Mulvagh SL, Kohli M. Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clin Proc. 2014;89(9):1287-306. doi: 10.1016/j.mayocp.2014.05.013
American Cancer Society. Chemotherapy for Breast Cancer [Online]. Disponível em https://www.cancer.org/cancer/breast-cancer/treatment/chemotherapy-for-breast-cancer.html>. Acesso em [30 mar 2022]
Witteles RM, Telli M. Underestimating cardiac toxicity in cancer trials: lessons learned? J Clin Oncol. 2012;30:1916-8. DOI: 10.1200/JCO.2011.40.4012
Kirkham AA, Lloyd MG, Claydon VE, Gelmon KA, McKenzie DC, Campbell KL. A Longitudinal Study of the Association of Clinical Indices of Cardiovascular Autonomic Function with Breast Cancer Treatment and Exercise Training. Oncologist. 2019;24:273–284. doi: 10.1634/theoncologist.2018-0049.
Feijen EAML, Font-Gonzalez A, Van der Pal HJH, Kok WEM, Geskus RB, Ronckers CM, et al. Risk and Temporal Changes of Heart Failure Among 5-Year Childhood Cancer Survivors: a DCOG-LATER Study. J Am Heart Assoc. 2019;8(1):e009122. doi: 10.1161/JAHA.118.009122.
Fiuza M, Ribeiro L, Magalhães A, Sousa AR, Menezes MN, Jorge M, Costa L, Pinto FJ. Organização e implementação de uma consulta de cardio‐oncologia. Revista Portuguesa de Cardiologia 2016;35(90):485-494. https://doi.org/10.1016/j.repc.2016.04.006.
Pinto CM, Silva DC, Pinto GH, dos Santos MHH. Quimioterapia e Cardiotoxicidade. Rev Soc Cardiol Estado de São Paulo 2017;27(4):266-73.
Raschi E, Vasina V, Ursino MG, Boriani G, Martoni A, De Ponti F. Anticancer drugs and cardiotoxicity: Insights and perspectives in the era of targeted therapy. Pharmacol Ther. 2010 Feb;125(2):196-218. doi: 10.1016/j.pharmthera.2009.10.002..
Cruz M, Duarte-Rodrigues J, Campelo M. Cardiotoxicidade na terapêutica com antraciclinas: estratégias de prevenção. Rev Port Cardiol. 2016;35(6):359-371. https://doi.org/10.1016/j.repc.2015.12.004
Cardinale D, Colombo A, Bacchiani G, Tedeschi I, Meroni CA, Veglia F, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation 2015;131:1981–8. doi: 10.1161/CIRCULATIONAHA.114.013777.
Argani IL, Arruda C, Schoueri J, et al. Avaliação da Cardiotoxicidade induzida por Quimioterapia em pacientes com Câncer de Mama. Clin Onc Let. 2018;3(1-2):37-44. https://doi.org/10.4322/col.2018.002
Avila MS, Siqueira SR, Ferreira SM, Bocchi EA. Prevention and treatment of chemotherapy-induced cardiotoxicity. Methodist Debakey Cardiovasc J. 2019;15:267-73. doi: 10.14797/mdcj-15-4-267
McGowan JV, Chung R, Maulik A, Piotrowska I, Walker JM, Yellon DM. Anthracycline Chemotherapy and Cardiotoxicity. Cardiovasc Drugs Ther. 2017;31(1):63-75. doi: 10.1007/s10557-016-6711-0
Karanth NV, Roy A, Joseph M, de Pasquale C, Karapetis C, Koczwara B. Utility of prechemotherapy echocardiographical assessment of cardiac abnormalities. Support Care Cancer 2011;19(12):2021-6. doi: 10.1007/s00520-010-1054-z.
Sawaya H, Sebag IA, Plana JC, et al. Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab. Circ Cardiovasc Imaging 2012;5(5):596-603. http://dx.doi.org/10.1161/CIRCIMAGING.112.973321
Bocchi EA, Braga FGM, Ferreira SMA, Rohde LEP, Oliveira WA, Almeida DR, et al. Sociedade Brasileira de Cardiologia. III Diretriz Brasileira de Insuficiência Cardíaca Crônica. Arquivos Brasileiros de Cardiologia 2009; 92(6 Suppl I):1-71.
Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology. Circulation 2006;114(10):e385-484. doi: 10.1161/CIRCULATIONAHA.106.178233.
Pai VB, Nahata MC. Cardiotoxicity of chemotherapeutic agents: incidence, treatment and prevention. Drug Saf. 2000 Apr;22(4):263-302. doi: 10.2165/00002018-200022040-00002.
Costa MP, Castier MB, Salgado CG. Papel do ecocardiograma na avaliação da cardiotoxicidade no tratamento do câncer de mama. Rev Bras Cardiol. 2011;24(6)382-386.
Rocha RM, Schneider RS, Moreira I. Cardio-oncologia – onde estamos. Revista HUPE 2013;12(Supl 1):93-99. doi: 10.12957/rhupe.2013.7087
Rosa PR, Ferreira IMM, Mendonca GS, Fernandes FV, Almeida RP, O’Connell JL, Resende ES. Severe Cardiac Insufficiency Secondary to Cardiotoxicity With Clinical and Morpho-Functional Improvement after Optimised Clinical Treatment: Case Report. Biosci. J. 2020;36(6):2281-2287. http://dx.doi.org/10.14393/BJ-v36n6a2020-48129
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Guilherme Silva de Mendonça, Elmiro Santos Resende
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors are copyright holders under a CCBY 4.0 license.
