Case study 22.3
Doxorubicin (Adriamycin) and herceptin are potentially cardiotoxic. What follow up advice and health promotion education should Deirdre receive?
Patients on doxorubicin (adriamycin) should undergo assessment of left ventricular cardiac function before starting treatment, during treatment and after treatment ends (to detect any delayed cardiotoxicity). The tests that are undertaken include a multigated acquisition (MUGA) scan which creates video images of the ventricles to check if they are pumping blood properly. It shows any abnormalities in the size of the ventricles and in the movement of the blood through the heart. Another test that can be undertaken is an echocardiogram (an ultrasound of the heart),
Similarly, with trastuzumab (herceptin), there is also a risk of cardiotoxicity but the risk factors are associated with previous or concurrent anthracycline use (Adriamycin belongs to that group of drugs) and if aged over 50 years. MUGA scans are used to detect any cardiotoxicity.
Patients should be advised to report any symptoms of heart failure including increased shortness of breath, decrease in energy levels, swollen ankles. These symptoms can occur while the patient is on treatment or when the treatment is over and they are in follow up. Patients should also be given general advice on healthy diet and exercise, monitoring of blood pressure and cholesterol level.