Risk and Management of Patients with Cancer and Heart Disease

Abstract

Cancer and cardiovascular disease are two of the leading causes of global mortality and morbidity. Medical research has generated powerful lifesaving treatments for patients with cancer; however, such treatments may sometimes be at the expense of the patient's myocardium, leading to heart failure. Anti-cancer drugs, including anthracyclines, can result in deleterious cardiac effects, significantly impacting patients' functional capacity, mental well-being, and quality of life. Recognizing this, recent international guidelines and expert papers published recommendations on risk stratification and care delivery, including that of cardio-oncology services. This review will summarize key evidence with a focus on anthracycline therapy, providing clinical guidance for the non-oncology professional caring for a patient with cancer and heart failure.

Keywords: Anthracycline; Cardiotoxicity; Heart failure; Risk stratification.

Fig. 1

Surveillance strategy for anthracycline-treated patients. Adapted from the ESC 2022 cardio-oncology guidelines. If Mean Heart Dose (MHD) is not available from patient records, the prescribed dose may be utilised. A MHD ≥15 Gy equates to ≥35Gy prescribed dose; A MHD 5-15 Gy equates to 15-34Gy prescribed dose; A MHD <5 Gy equates to <15 Gy prescribed dose [4]. AC anthracycline, BP blood pressure, BMI body mass index, CV cardiovascular, D.E. doxorubicin equivalent, ECG electrocardiogram, Gy grays, Hx history, M months, MHD mean heart dose, NP natriuretic peptide, RTx radiotherapy, Tx treatment, U&E urea and electrolytes, Y years. * If abnormal, refer to cardio-oncology;^(*) consider cardio-oncology referral

Fig. 2

Specialized multidisciplinary teams embedded within the cardio-oncology service