Cardio-oncology: need for novel structures

Abstract

Cancer and cardiovascular diseases are the main causes for morbidity and mortality in modern society. In the United States of America (USA), over 1.7 million new cancer cases will presumably be observed in 2018. Progress in cancer treatment has greatly improved survival and it is estimated that 15.5 million cancer survivors currently live in the USA. The number of cancer survivors is expected to increase by 68% until 2040. Moreover, the portion of cancer survivors at the age of 65 years or older will increase from 62% to approximately 73% in 2040 which in turn enhances comorbidities in cancer survivors. Increased survival and age of cancer patients has unmasked the burden of cancer and cancer therapy-associated cardiovascular diseases. Depending on cancer treatment modalities, early cardiovascular toxicity is observed in up to 48% of patients. Late cardiotoxicity can be found in 30% of patients at 13 years after cancer treatment. Cardio-oncology aims to identify cancer therapy-related cardiovascular side effects and to provide optimum multidisciplinary care for cancer patients. So far, scientific effort has generated a profound knowledge on underlying pathomechanisms and clinical implications but standardized recommendations and structural requirements for cardio-oncology care are still limited.

Keywords: Anthracyclines; Cancer; Cardio-oncology; Cardiotoxicity.

Fig. 1

Workflow of a cardio-oncology unit. Treating oncologists identify patients with high risk for cardiovascular adverse events for cardio-oncologic consultation. The cardio-oncology unit conducts a baseline assessment before therapy, monitoring of cardiovascular toxicities during therapy and follow-up after therapy. Cardio-oncology benefits from multidisciplinary cooperation. Integration within a clinical research program facilitates scientific progress