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Cancer Therapies and Cardiac Dysfunction
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Victoria Shklar, Katherine Godfrey, Michelle E. Bloom
The aging population of cancer patients lends itself to a higher burden of cardiovascular risk factors, comorbidities, and poor cardiac reserve. Insufficient evidence regarding long-term consequences of cancer treatment-related CVD (CTRCD) might lead to ineffective prevention of adverse events and possible inappropriate interruption of life-saving therapies. Current research is aimed at identifying the best surveillance and prevention strategies to identify those at risk of early cardiac toxicity. Many cardiologists and oncologists still regard the left ventricular ejection fraction (LVEF) as the determining factor for cardiac toxicity. Unfortunately, by the point of LVEF decline, many patients have already presented with clinical heart failure (HF). Because the field of cardio-oncology and the topic of cardiac toxicity related to cancer therapy is vast and diverse, this chapter will focus on cancer treatment-related cardiomyopathy and HF.
Cardio-oncology: How a new discipline arrived
Published in Susan F. Dent, Practical Cardio-Oncology, 2019
Susan F. Dent, Nestor Gahungu, Moira Rushton-Marovac, Josee Ivars, Carlo Cipolla, Daniel J. Lenihan
Cardio-oncology as a discipline has developed from recognition of the complexities involved in treating patients with cancer who are at risk of or develop cancer therapy related cardiac dysfunction. In a nationwide online survey of 444 adult and pediatric cardiology division chiefs and CV fellowship training directors, 39% of participants did not feel confident dealing with the specific CV needs of cancer patients (31). This alarming statistic alone speaks to the need for coordinated care, communication and education between oncologists and cardiologists.
Oncologic therapies associated with cardiac toxicities: how to minimize the risks
Published in Expert Review of Anticancer Therapy, 2019
Daniela Cardinale, Federica Stivala, Carlo M. Cipolla
Cardiotoxicity induced by cancer therapies remains a serious problem that affects both quality of life and overall survival of cancer patients, independently of the oncological prognosis. Consequently, the identification and the management of cancer patients at high risk for cardiotoxicity has become crucial to reduce morbidity and mortality in this clinical setting. Several strategies have been proposed to mitigate the risk of cardiotoxicity, and there is promising evidence that the prevention of this complication is a possible objective, but it requires a multidisciplinary approach and close collaboration between cardiologists and oncologists [104]. A new medical discipline, Cardio-Oncology, has been created to face this need. Cardio-Oncology is a new interdisciplinary medical field of growing interest, based on a thorough approach to the management of cardiovascular complications in patients undergoing cancer treatments. Accordingly, a new medical figure has been identified, the cardioncologist, generally a cardiologist, an expert in the management of cardiovascular problems in cancer patients. The cardioncologist’s main aims are to avoid the possibility that cancer therapy could induce cardiac disease – preventing the oncologic patient cured today from becoming the heart patient of tomorrow.
Update on the management of chronic myeloid leukemia: current best practice and future directions
Published in Expert Opinion on Orphan Drugs, 2019
Aisling Nee, Jeffrey H. Lipton
With the increasing use of second- and third-generation TKIs, cardiovascular surveillance and management is of increasing importance. In some tertiary care centers, Cardio-oncology services assist in provision of structured cardiovascular assessment and surveillance. However, many patients with CML are managed by general hematologists. Baseline cardiovascular risk-factor assessment and aggressive management of cardiovascular risk-factors need to be undertaken and are of greatest importance in patients commencing therapy with Nilotinib or Ponatinib. We perform a baseline cardiovascular assessment in all CML patients commencing TKI therapies in collaboration with our Cardio-oncology colleagues. Patients with pre-existing cardiovascular disease or cardiac risk factors have ongoing cardio-oncology follow up. All patients have monitoring of cardiovascular risk factors (blood pressure, lipids, and glucose) performed 3–6 monthly and we implement tight control of these risk factors in collaboration with Cardio-oncology. We have a low threshold to commence statin therapy to control LDL cholesterol, to a target of < 2 mmol/L for patients at high risk for cardiovascular complications based on cardiovascular assessment and TKI therapy [112]. Importantly certain medications including simvastatin and atorvastatin can interact with TKIs, so we usually recommend rosuvastatin or pravastatin where lipid-lowering therapy is needed.
Development of an Outpatient Cardio-oncology Program
Published in Oncology Issues, 2018
Laurie Walton Fitzgerald, Peyton Neilson
With this combined cardiology and oncology program, Kaufman Cancer Center looked to provide early recognition of those at risk, monitor minute changes of cardiac toxicity, and track possible changes into survivorship. The goal of the cardio-oncology program was twofold: to (1) provide optimal overall care of cancer patients with or without cardiac disease and (2) understand and manage their risk for cardiovascular manifestation related to chemotherapy agents. The cardio-oncology program would also help: Reduce cancer treatment–related cardiovascular adverse effectsProvide quality outcomesImprove patients' quality of life.