Advancing Cardio-Oncology in Asia

Abstract

Cardio-oncology is an emerging multi-disciplinary field, which aims to reduce morbidity and mortality of cancer patients by preventing and managing cancer treatment-related cardiovascular toxicities. With the exponential growth in cancer and cardiovascular diseases in Asia, there is an emerging need for cardio-oncology awareness among physicians and country-specific cardio-oncology initiatives. In this state-of-the-art review, we sought to describe the burden of cancer and cardiovascular disease in Asia, a region with rich cultural and socio-economic diversity. From describing the uniqueness and challenges (such as socio-economic disparity, ethnical and racial diversity, and limited training opportunities) in establishing cardio-oncology in Asia, and outlining ways to overcome any barriers, this article aims to help advance the field of cardio-oncology in Asia.

Keywords: Asia; Cancer; Cardio-oncology; Cardiotoxicity; Onco-cardiology.

Figure 1. Deaths by cause, South-East Asia region (WHO), 1990–2019, showing a shift in mortality from communicable, maternal, neonatal and nutritional disease to non-communicable diseases in South-East Asia.

NCD = non-communicable disease; WHO = World Health Organization.

Figure 2. Burden of disease by cause, world, 2019. Total disease burden, measured in DALYs by sub-category of disease or injury. DALYs measure the total burden of disease—both from years of life lost due to premature death and years lived with a disability. One DALY equals one lost year of healthy life.

DALY = disability-adjusted life year; HIV/AIDS = human immunodeficiency virus/acquired immunodeficiency syndrome; NCD = non-communicable disease; STI = sexually transmitted infection; TB = tuberculosis.

Figure 3. Top cancer per country, estimated age-standardized incidence rates in 2020, both sexes, all ages, excluding NMSC.

NMSC = non-melanoma skin cancer. Data source: GLOBOCAN 2020; Map production: International Agency for Research on Cancer, World Health Organization.

Figure 4. Survival outcomes from time of cancer diagnosis stratified by pre-existing and/or newly-diagnosed cardiovascular disease in South Korea.

Figure 5. (A) Data on from 2015 ESMO International Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in countries outside of Europe: Asian data for medications on the WHO Model List of Essential Medicines: formulary availability and out-of-pocket costs. (B) Data from the 2015 ESMO International Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in countries outside of Europe: Asian data of recently approved medications not on the WHO Model List of Essential Medicines, with an ESMO-MCBS score greater than 2: formulary availability and out-of-pocket costs.

Abirat = abiraterone; Aftatin = atafinib; Anast = anastrozole; Axitin = axitinib; Bleo = bleomycin; Capecit = capecitabine; CarboP = carboplatin; Cetux = cetuximab; CisP = cisplatin; Crizot = crizotinib; CRC = colorectal cancer; Cyclo = cyclophosphamide; DTIC = dacarbazine; Docet = docetaxel; Enzalut = enzalutamide; Epir = eprirubicin; Erlot = erlotinib; ESMO = European Society for Medical Oncology; Etop = etoposide; Everol = everolimus; Gefit = gefitinib; Ifos = ifosfamide; Ipilim = ipilimumab; Irino = irinotecan; Lapat = lapatinib; MBC = metastatic breast cancer; MCBS = Magnitude of Clinical Benefit Scale; Melan = melanoma; MTX = methotrexate; Oxalipl = oxaliplatin; Paclit = paclitaxel; Panitum = panitumumab; Pazop = pazopanib; Pertuz = pertuzumab; Prost = prostate; RCC = renal cell cancer; Soraf = sorafenib; Suni = sunitinib; Tam = tamoxifen; Temsir = temsirolimus; Trastuz = trastuzumab; VBL = vinblastine; VCR = vincristine; Vemuraf = vemurafenib; WHO = World Health Organization.

Figure 6. Outcomes of a cardio-oncology in Taiwan.

HF = heart failure; HTN = hypertension; MI = myocardial infarction.

Figure 7. Worldwide distribution of International Cardio-Oncology Society Centers of cardio-oncology excellence.

ICOS = International Cardio-Oncology Society.

Figure 8. Central elements of cardio-oncology training.

Figure 9. Intradisciplinary and cross-specialty collaboration among cardiologists, hematologist and oncologists in cardio-oncology.

Figure 10. Key components of a cardio-oncology program.

ACC = American College of Cardiology; ASCO = American Society of Clinical Oncology; CV = cardiovascular.