The European Society of Cardiology (ESC) has recently published in the European Heart Journal a Position Paper in which cardiovascular complications of anticancer therapy are divided into nine main categories and further discussed in term of pathophysiology and clinical presentation, diagnostic and therapeutic management:
- myocardial dysfunction and heart failure
- coronary artery disease
- valvular disease
- arrhythmias, especially those induced by QT-prolonging drugs
- arterial hypertension
- thromboembolic disease
- peripheral vascular disease and stroke
- pulmonary hypertension and
- pericardial complications.
The document was developed under the auspices of the ESC Committee for Practice Guidelines by a Task Force chaired by Jose Zamorano and Patrizio Lancelotti and including representatives of the International CardioOncology Society (ICOS). The document covers all aspects of cardiovascular toxicity in the context of anticancer treatment, providing expert opinion for management (given the paucity of randomised evidence) and summarising the most important recommendations.
Advances in anticancer treatment have led to improved survival of patients with cancer, but have also increased morbidity and mortality due to treatment side effects. Cardiovascular diseases 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 cardiovascular disease, especially in the presence of traditional cardiovascular risk factors, the authors wrote in an introductory part of the document.
Many aspects of both radiation- and anticancer drug–induced cardiovascular disease are still to be fully elucidated. The authors underlined that the complex issue of cardiovascular disease as a consequence of previous anticancer treatment requires the creation of multidisciplinary teams involving specialists in cardiology, oncology and other related fields. However, the extent of care and the interaction between the disciplines involved has not yet been defined.
The authors also wrote that a complexity of the clinical questions to be addressed by cardio-oncologists will require 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.
They emphasised that 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.
The document reviews the different steps in cardiovascular monitoring and decision-making before, during and after anticancer 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 in aspects of care related to cardiovascular toxicity induced by anticancer treatment. The paper provides a valuable resource not only to professionals involved in cancer care, but to all healthcare professionals exposed to cardiovascular diseases.
Zamorano JL, Lancellotti P, Muñoz DR, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37(36):2768-2801.