New-Onset Cancer in the HF Population: Epidemiology, Pathophysiology, and Clinical Management

Abstract

Purpose of review: Oncological treatments are known to induce cardiac toxicity, but the impact of new-onset cancer in patients with pre-existing HF remains unknown. This review focuses on the epidemiology, pathophysiological mechanisms, and clinical implications of HF patients who develop malignancies.

Recent findings: Novel findings suggest that HF and cancer, beside common risk factors, are deeply linked by shared pathophysiological mechanisms. In particular, HF itself may enhance carcinogenesis by producing pro-inflammatory cytokines, and it has been suggested that neurohormonal activation, commonly associated with the failing heart, might play a pivotal role in promoting neoplastic transformation. The risk of malignancies seems to be higher in HF patients compared to the general population, probably due to shared risk factors and common pathophysiological pathways. Additionally, management of these patients represents a challenge for clinicians, considering that the co-existence of these diseases significantly worsens patients' prognosis and negatively affects therapeutic options for both diseases.

Keywords: Cancer; Cancer and heart failure risk factors; Cardio-oncology; Epidemiology; Heart failure; Physiopathology.

Fig. 1

Summary of the epidemiology, pathophysiological mechanisms, and the clinical implications characterizing HF patients who develop malignancies. List of abbreviation: HF, heart failure