Advances in cancer treatment have improved the survival of patients, but have also increased morbidity and mortality due to treatment side effects. The effects of cancer treatments on the cardiovascular system are garnering more attention. This led a task force at the European Society of Cardiology (ESC) to publish a novel position paper on tackling the cardiac toxicity of anticancer therapies. The cardio-oncology paper was published online in European Heart Journal and on the ESC website.
Under the auspices of the ESC Committee for Practice Guidelines, the paper aims to provide an expert consensus regarding the current standards of care for patients with cardiotoxicity due to cancer treatment. Task force members noted that many aspects of both radiation- and cancer-induced cardiovascular disease (CVD) are still unknown. They stated, “The inability to predict the long-term consequences of cancer treatment–associated cardiovascular side effects leads to under- or overdiagnosis of CVD, sometimes resulting in the failure to prevent adverse events and sometimes to inappropriate interruption of a potentially lifesaving cancer treatment.”
The document outlines how anticancer therapies can harm the heart. There are nine main categories of cardiovascular complications of anticancer therapy: 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.
For each complication, the paper describes which patients are at risk, and how to detect and prevent potential side effects as well as recommendations on treatment and follow-up on patients who develop that category of cardiotoxicity. The document also addresses long-term surveillance for cancer survivors. Patients should be informed of their increased risk of CVD at the start of chemotherapy, supported to make appropriate lifestyle modifications, and instructed to promptly report early signs and symptoms of CVD.
Furthermore, the task force noted the importance of multidisciplinary teams involving specialists in cardiology, oncology, and related fields to provide the best care for patients and survivors. Ultimately, cardio-oncology centers with a structured service should be established.