“Advances in treatment have led to improved survival of patients with cancer, but have also increased morbidity and mortality due to treatment side effects. Cardiovascular diseases (CVDs) are one of the most frequent of these side effects, and there is a growing concern that they may lead to premature morbidity and death among cancer survivors. This may be the result of cardiotoxicity, which involves direct effects of the cancer treatment on heart function and structure, or may be due to accelerated development of CVD, especially in the presence of traditional cardiovascular risk factors.”
“Although the field of cardio-oncology has received increasing attention in recent years, many aspects of both radiation-induced and cancer drug–induced CVD are still to be fully elucidated. Furthermore, the inability to predict the long-term consequences of cancer treatment–associated cardiovascular side effects leads to under- or overdiagnosis of CVD, sometimes resulting in the failure to prevent adverse events and sometimes to inappropriate interruption of a potentially lifesaving cancer treatment.
The complex issue of CVD as a consequence of previous cancer treatment requires the creation of multidisciplinary teams involving specialists in cardiology, oncology and other related fields. The mutual interest to provide optimal care for patients with cancer and cancer survivors is an important motivation for the development of cardio-oncology teams. However, the extent of care and the interaction between the disciplines involved has not yet been defined. The complexity of the clinical questions to be addressed by cardio-oncologists will require the definition of a curriculum describing the necessary knowledge and skills to deliver optimal care and the hospital setting in which these experts will be active. These cardio-oncology teams should also be involved in the long-term surveillance of cancer survivors with a potential for late-onset cardiovascular complications and in the development of potential new treatments that may have cardiotoxic effects, as well as in the evaluation of cardiac events related to such drugs.
This document reviews the different steps in cardiovascular monitoring and decision-making before, during and after cancer treatment with potential cardiovascular side effects. Although this document is not a formal clinical practice guideline, it aims to assist professionals involved in the treatment of patients with cancer and survivors by providing an expert consensus regarding current standards of care for these individuals.
In general, the cardiovascular complications of cancer therapy can be divided into nine main categories, which are discussed in this document:
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myocardial dysfunction and heart failure (HF);
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coronary artery disease (CAD);
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valvular disease;
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arrhythmias, especially those induced by QT-prolonging drugs;
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arterial hypertension;
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thromboembolic disease;
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peripheral vascular disease and stroke;
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pulmonary hypertension and
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pericardial complications.”