Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management

open access
 26 FEB 2016
 

Introduction

Mortality rates from cancer have declined over the past 30 years largely because of early detection strategies, improved surgical approaches, as well as advances in cancer therapeutics.[1-3] Improvement in survivorship, however, can be associated with other organ injuries, including impact on cardiovascular health.[4] Cardiovascular (CV) disease (CVD) is now the second leading cause of long-term morbidity and mortality among cancer survivors.[1-3, 5, 6] Conventional chemotherapy and targeted therapies are associated with an increased risk of cardiac damage, including left ventricular (LV) dysfunction (LVD) and heart failure (HF),[7, 8] treatment-induced hypertension, vasospastic and thromboembolic ischemia, as well as rhythm disturbances, including conduction system damage and potentially QTc prolongation, that may be rarely life-threatening. Although some of these cardiac adverse effects are irreversible and cause progressive CVD, others induce only temporary dysfunction with no apparent long-term sequelae.[9] Early and late effects of chest radiation can lead to radiation-induced heart disease (RIHD), which may involve a spectrum of cardiac conditions, such as pericardial disease, myocardial fibrosis, cardiomyopathy, coronary artery disease (CAD), valvular disease, and arrhythmias in the setting of myocardial fibrosis.[10] Oncologists face the challenge of treating patients with the best cancer therapies available without adversely impacting CV health. The discipline of cardio-oncology has developed in response to the combined decision making necessary to optimize the care of patients with cancer, whether they are receiving active treatment or are long-term survivors after successful treatment. This review will focus on the common CV issues that may arise during or after cancer therapy, the detection and monitoring of CV injury, and the best management principles to protect or minimize the impact of CV issues during the spectrum of cancer therapies.....


 

Conclusions

Modern cancer treatment strategies have led to a significant improvement in the chances of surviving a diagnosis of cancer for many years. These gains in overall outcome may be offset by the potential negative impact of cancer therapy on CV health. Cancer therapies may have short-term and long-term side effects involving the heart and circulation, as well as exacerbating and/or unmasking existing heart disease. The development of CV disease during the course of cancer treatment can adversely impact the management of the underlying malignancy by interfering with the optimal doses and timing of lifesaving cancer therapy. In addition, the development of a potentially important cancer therapy may be halted or abandoned because of a perceived increased CV risk. The discipline of cardio-oncology has developed in response to the combined decision making necessary to optimize the care of patients with cancer, whether they are receiving active treatment or are long-term survivors after successful treatment (Fig. 1). Cardiology and oncology organizations around the world (ie, European Society for Medical Oncology, American College of Cardiology, ASCO, European Society of Cardiology, Canadian Cardiovascular Society) are now recognizing the importance of this collaboration, resulting in the ongoing development of several clinical practice guidelines and position statements.[94, 164, 165] Although these initiatives will provide important guidance for clinicians on best practices for patients today, many questions remain unanswered: How can we predict who will develop cardiotoxicity, what is the best prevention strategy, how should we monitor those at risk of cardiotoxicity, and what are the best management strategies? There is an urgent need for collaborative research to address these questions. Vibrant collaborative partnerships between oncologists, cardiologists, and other allied health care professionals will play an important role in the development and promotion of clinical care models, educational programs (for patients and health care providers), and evidence-based research to improve the care of patients being treated for cancer.