Jean Domercant1, Nichole Polin2, Eiman Jahangir3. 1. Department of Internal Medicine, Leonard J. Chabert Medical Center, Houma, LA. 2. Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA. 3. Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA.
Abstract
BACKGROUND: Cardio-oncology is a collaborative approach between cardiologists and oncologists in the treatment of patients with cancer and heart disease. Radiation and chemotherapy have played a major role in the decreased cancer-related mortality achieved in the past 2 decades. However, anthracycline-, tyrosine kinase-, and radiation-based therapies are each associated with independent cardiovascular (CV) risks, and these risks are cumulative when these therapies are used in combination. METHODS: We analyzed several published articles, studies, and guidelines to provide a focused review of cardiotoxicity associated with anthracyclines, human epidermal growth factor receptor 2 inhibitors, and radiation therapy and its management. RESULTS: The focus on CV risk among individuals being treated with cardiotoxic agents is important because once the cancer is cured, CV disease becomes the number 1 cause of death among cancer survivors. Cardio-oncology focuses on assessing CV risk prior to starting therapy, optimizing modifiable risk factors, and providing surveillance and treatment for any early signs of cardiotoxicity in patients undergoing radiation and chemotherapy. A collaborative approach between oncologists and cardiologists is integral to the optimal care of patients with cancer. Although radiation and chemotherapy treatments have evolved with the aim of targeting cancer cells while having minimal effect on the heart, the increased risk of cardiomyopathy in patients receiving these treatments remains significant. CONCLUSION: Proper screening and treatment of cardiotoxicity are essential for patients with cancer. As cardiac diseases and cancer remain the first and second causes of mortality in developed nations, respectively, cardio-oncology is the answer to this group of individuals who are especially vulnerable to both causes of mortality.
BACKGROUND: Cardio-oncology is a collaborative approach between cardiologists and oncologists in the treatment of patients with cancer and heart disease. Radiation and chemotherapy have played a major role in the decreased cancer-related mortality achieved in the past 2 decades. However, anthracycline-, tyrosine kinase-, and radiation-based therapies are each associated with independent cardiovascular (CV) risks, and these risks are cumulative when these therapies are used in combination. METHODS: We analyzed several published articles, studies, and guidelines to provide a focused review of cardiotoxicity associated with anthracyclines, humanepidermal growth factor receptor 2 inhibitors, and radiation therapy and its management. RESULTS: The focus on CV risk among individuals being treated with cardiotoxic agents is important because once the cancer is cured, CV disease becomes the number 1 cause of death among cancer survivors. Cardio-oncology focuses on assessing CV risk prior to starting therapy, optimizing modifiable risk factors, and providing surveillance and treatment for any early signs of cardiotoxicity in patients undergoing radiation and chemotherapy. A collaborative approach between oncologists and cardiologists is integral to the optimal care of patients with cancer. Although radiation and chemotherapy treatments have evolved with the aim of targeting cancer cells while having minimal effect on the heart, the increased risk of cardiomyopathy in patients receiving these treatments remains significant. CONCLUSION: Proper screening and treatment of cardiotoxicity are essential for patients with cancer. As cardiac diseases and cancer remain the first and second causes of mortality in developed nations, respectively, cardio-oncology is the answer to this group of individuals who are especially vulnerable to both causes of mortality.
Authors: J M Bennett; H B Muss; J H Doroshow; S Wolff; E T Krementz; K Cartwright; G Dukart; A Reisman; I Schoch Journal: J Clin Oncol Date: 1988-10 Impact factor: 44.544
Authors: D D Von Hoff; M W Layard; P Basa; H L Davis; A L Von Hoff; M Rozencweig; F M Muggia Journal: Ann Intern Med Date: 1979-11 Impact factor: 25.391
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Authors: Sui Zhang; Xiaobing Liu; Tasneem Bawa-Khalfe; Long-Sheng Lu; Yi Lisa Lyu; Leroy F Liu; Edward T H Yeh Journal: Nat Med Date: 2012-10-28 Impact factor: 53.440
Authors: R G Schwartz; W B McKenzie; J Alexander; P Sager; A D'Souza; A Manatunga; P E Schwartz; H J Berger; J Setaro; L Surkin Journal: Am J Med Date: 1987-06 Impact factor: 4.965
Authors: Elke Martin; Annemette Vinding Thougaard; Morten Grauslund; Peter B Jensen; Fredrik Bjorkling; Brian B Hasinoff; Jette Tjørnelund; Maxwell Sehested; Lars H Jensen Journal: Toxicology Date: 2008-10-25 Impact factor: 4.221