chemotherapeutics

By 2026, it is anticipated that there will be more than 20 million cancer survivors in the US¹. The increase in prevalence of cancer survivors is largely due to discovery and implementation of effective chemotherapeutics and radiation therapy.  This success has come with a price, however, as the same chemotherapeutics and radiation therapy that cure cancer also damage vital organs, such as the heart. A wide range of chemotherapeutics have been associated with coronary artery disease, pericardial disease, and thromboembolic disease. Radiation therapy may accelerate premature atherosclerosis through acute inflammation leading to early vasculopathy in irradiated regions. With the introduction of each effective novel agent in treatment that prolongs survival,  side effects may  affect patient health and quality of life.

These factors have prompted the newly published AHA Scientific Statement on the field of Cardio-oncology, focused on the vascular and metabolic ramification of cancer treatment². Cardio-oncology is a rapidly growing field of study given the prevalence of cancer and the need for physicians to address the unique challenges of treatment of cardiovascular disease in the cancer population.

Similar to general cardiology, prevention is a vital aspect of the field of cardio-oncology. This is due to the fact that both detection and treatment of cardiotoxicity is difficult. Symptomatically, cardiotoxicity can take years to manifest with the use of certain chemotherapeutics  and detection of subclinical cardiotoxicity is challenging. Thus, monitoring and screening become the most effective ways to minimize risk of development of cardiotoxicity and vascular complications.

Care in the cancer population should be multi-disciplinary from the moment the decision is made on the chemotherapeutics/radiation cycle to be used in treatment. Oncologist, cardiologists, and primary care physician are a vital part of care and must work together to make sure patients are medically optimized before start of treatment regimens. This includes thorough risk stratification and analysis of the benefits of treatment modalities, which needs to be individualized. Demographic factors such as the patient’s family history, prior cardiac history, current exercise tolerance are important factors to consider. Identification of patients at high risk would allow for consideration of alternative therapy, closer monitoring, screening, and possibly prophylactic treatment with cardioprotective medications. These patients can be monitored closely and undergo regular screening for signs of ventricular dysfunction.

Cardio-oncology is an exciting field of study with many unanswered questions. As literature continues to grow, I hope that we can meet the many challenges of cancer treatment.

References:

1. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. 2016. Cancer treatment and survivorship statistics. CA: A Cancer Journal for Clinicians 66 271–289.
2. Campia U, Moslehi JJ, Amiri-kordestani L, et al. Cardio-Oncology: Vascular and Metabolic Perspectives: A Scientific Statement From the American Heart Association. Circulation. 2019;139(13):e579-e602.