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Review
. 2020 Dec;22(12):2290-2309.
doi: 10.1002/ejhf.1985. Epub 2020 Oct 2.

The cancer patient and cardiology

José Luis Zamorano  1 , Christer Gottfridsson  2 , Riccardo Asteggiano  3   4 , Dan Atar  5   6 , Lina Badimon  7 , Jeroen J Bax  8 , Daniela Cardinale  9 , Antonella Cardone  10 , Elizabeth A M Feijen  11 , Péter Ferdinandy  12   13 , Teresa López-Fernández  14 , Chris P Gale  15 , John H Maduro  16 , Javid Moslehi  17 , Torbjørn Omland  18 , Juan Carlos Plana Gomez  19 , Jessica Scott  20 , Thomas M Suter  21 , Giorgio Minotti  22
Affiliations
Review

The cancer patient and cardiology

José Luis Zamorano et al. Eur J Heart Fail. 2020 Dec.

Abstract

Advances in cancer treatments have improved clinical outcomes, leading to an increasing population of cancer survivors. However, this success is associated with high rates of short- and long-term cardiovascular (CV) toxicities. The number and variety of cancer drugs and CV toxicity types make long-term care a complex undertaking. This requires a multidisciplinary approach that includes expertise in oncology, cardiology and other related specialties, and has led to the development of the cardio-oncology subspecialty. This paper aims to provide an overview of the main adverse events, risk assessment and risk mitigation strategies, early diagnosis, medical and complementary strategies for prevention and management, and long-term follow-up strategies for patients at risk of cancer therapy-related cardiotoxicities. Research to better define strategies for early identification, follow-up and management is highly necessary. Although the academic cardio-oncology community may be the best vehicle to foster awareness and research in this field, additional stakeholders (industry, government agencies and patient organizations) must be involved to facilitate cross-discipline interactions and help in the design and funding of cardio-oncology trials. The overarching goals of cardio-oncology are to assist clinicians in providing optimal care for patients with cancer and cancer survivors, to provide insight into future areas of research and to search for collaborations with industry, funding bodies and patient advocates. However, many unmet needs remain. This document is the product of brainstorming presentations and active discussions held at the Cardiovascular Round Table workshop organized in January 2020 by the European Society of Cardiology.

Keywords: Cancer drugs; Cardio-oncology; Cardiovascular toxicity; Detection; Long-term follow-up; Prevention.

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Conflict of interest statement

Conflict of interest: C.G. reports salary received as an employee of AstraZeneca, outside the submitted work. J.J.B. reports the receipt of personal fees as a speaker for Abbott and Edwards Lifescience, outside the submitted work. P.F. reports the receipt of grants from Semmelweis University and the Pharmahungary Group during the conduct of the study, is the founder and chief executive officer of the Pharmahungary Group, a group of research and development companies developing cardioprotective drug therapeutics and digital therapeutics related to drug safety, outside the submitted work, and reports an issued software copyright for www.mirnatarget.com, and a pending software copyright for www.vigilace.com. T.L.F. reports the receipt of personal fees from Janssen, Servier, Amgen, Philips, MSD and Daiichi Sankyo, outside the submitted work. C.P.G. reports his position as chair of the European Society of Cardiology EurObservational Research Programme Oversight Committee. T.O. reports the receipt of non-financial support from Novartis, grants and personal fees from Roche and Abbott, grants and stock from CardiNor, personal fees from Siemens and Bayer, and non-financial support from Singulex and SomaLogic, outside the submitted work. All other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Cardio-oncology care pillars: a conceptual framework of cardio-oncology initiatives.
Figure 2
Figure 2
Effects of exercise training on multisystem toxicities.,– CV, cardiovascular; CVD, cardiovascular disease; NO, nitric oxide.
Figure 3
Figure 3
Visual summary of strategies for baseline and long-term monitoring of cardiotoxicities in patients with cancer. BNP, B-type natriuretic peptide; CV, cardiovascular; CVD, cardiovascular disease; CMR, cardiac magnetic resonance; ECG, electrocardiogram; hs-TnI or TnT, high-sensitivity-cardiac troponins (I or T); MUGA, multi-gated acquisition; NT-proBNP, N-terminal pro-B-type natriuretic peptide.
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