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