The Future Role of Cardio-oncologists
Introduction
Cardiovascular (CV) disease and cancer remain the two most common causes of mortality in developed countries.
The lifetime probability of being diagnosed
with an invasive cancer is higher for men (43 %) than for women (38 %)
Conclusion
Wide Spectrum of Cardiovascular Complications
of Cancer Treatment
Myocardial dysfunction is associated with
a broad spectrum of anticancer treatment
Serial evaluation of symptoms, ECG and echocardiography focused on left ventricle fuction were seen to be sufficient to cover all cardiotoxicity
The term cardiotoxicity of cancer therapy was established for the development of heart failure as a result of anticancer treatment.
anthracyclines, alkylating agents, tyrosine kinase inhibitors, antimetabolites, etc
They are divided into nine categories according to their pathophysiology and clinical manifestation
Basic Concept for the Management of Patients
Treated with Potentially Cardiotoxic Drugs
. The main part of the general strategy to minimise the CV risks of anticancer treatment is baseline risk assessment with the aim to identify patients who are at higher risk of CV complications.
There are four factors for CV risk
Previous cardiotoxic
cancer treatment
Demographic risk factors
Current myocardial disease
Life-style risk factors
Heart failure including asymptomatic left ventricular dysfunction; evidence of coronary artery disease; moderate or severe valvular heart disease; arterial hypertension with impaired LVF; hypertrophic, dilated or restrictive cardiomyopathy; cardiac sarcoidosis; and arrhythmias (AF and ventricular arrhythmias)
Prior anthracycline medication, and chest and
mediastinal irradiation
Age, family history of premature CV disease, arterial hypertension, diabetes mellitus and hypercholesterolemia
High alcohol intake, obesity, sedentary lifestyle and smoking
The regimen of the diagnostic
tools for the detection of cardiotoxicity consists of:
ECG
resting tachycardia, ST-T changes, conduction disturbances and QT interval prolongation
Echocardiography
nuclear cardiac imaging
2D or 3D LVEF assessment, global
longitudinal strain, pericardial effusion, etc.
LVF assessment using multigated radionuclide angiography
cardiac MRI
LVF and structural changes of the myocardium
biomarker assessment
challenging data were published on troponins and natriuretic peptides, which seems to be helpful to identify the patients at higher risk or those with early manifestation of cardiotoxicity
Cardio-oncology Team and Cardio-oncology
Subspeciality
The complexity of the cancer treatment requires tight co operation between oncologist and cardiologist
Detect early signs of cardiotoxicity and to take appropriate measures to solve complications.
This new situation has led to the development of the new cardiology subspecialty in cardio-oncology
Cardio-oncology Clinic
Some key components for the
effective work of the cardio-oncology centre are
Appropriate location
Experienced staff
High level of programme leadership
CV testing (
The cardio-oncology nurse coordinator can be a useful member of the cardio-oncology team.
The aim of the co-ordinator should be patient care co-ordination, triaging urgent CV issues and patient education.
Effective cardiotoxicity management needs to be comprehensive.
Aiming not only at minimising the mortality and mobility of this group of patients but primarily for improving the quality of life, including the return-to-work process.
This requires close co-operation between medical professionals (oncologists and cardiologists) and education not only within the medical community but also for the general public.
These are the processes that must be led by medical societies in a discussion with other partners involved in the treatment of oncological patients: healthcare providers