New advice aims to reduce cardiac side effects of cancer treatment

New advice aims to reduce cardiac side effects of cancer treatment

The first European Society of Cardiology (ESC) guideline on cardio-oncology was published online today in the European Heart Journal. The advice aims to reduce the cardiac side effects of cancer treatment so that patients can receive their therapy safely.

Cancer treatments such as chemotherapy, radiation, targeted therapy and immunotherapy have the potential to cause cardiovascular disease. Because of the success of cancer therapy in extending survival, more and more people are now living with heart disease as a result of their treatment. Survivors of multiple solid cancers and lymphoma have twice the risk of fatal heart disease compared to their peers.

This document is intended for healthcare professionals who care for cancer patients and survivors. It provides specific recommendations for management before, during and after the administration of cancer therapies that have the potential to cause problems with the heart or blood vessels.”

Dr. Alexander Lyon from Royal Brompton Hospital, London, UK

The first important question is that oncologists and hematologists know which therapies can cause heart problems. The second problem is that specific cancer treatments do not cause the same level of risk in all patients. Therefore, a baseline cardiovascular assessment is recommended to identify patients at high risk; You should be referred to a cardiologist for further cardiac evaluation and optimization of heart health and risk factors before starting therapy. “This preliminary assessment by the cardiologist must be carried out urgently to minimize delays in starting cancer treatment,” said Dr. Teresa Lopez-Fernandez, Chair of the Guidelines Task Force, La Paz University Hospital, Madrid, Spain.

The frequency of cardiac monitoring, known as surveillance, during treatment that could cause heart disease, and the ability to start heart medication beforehand to act as protection during cancer treatment, can be tailored to each cancer patient based on the baseline risk and type and total duration and dose of cancer therapy, as well as any pre-existing heart disease.

Maintaining and monitoring heart health during cancer treatment is an essential part of the guideline. Patients should be informed about the potential risks and how they can reduce them, e.g. B. stop smoking, exercise for at least 150 minutes per week, but not to the point of exhaustion, eat healthily and limit alcohol consumption to 100 grams per week. Possible cardiac symptoms such as chest pain, shortness of breath, fainting, fainting, or rapid heartbeat (palpitations) should be reported to the cancer team. Strict control of high blood pressure, diabetes and high cholesterol is recommended. Some patients are advised to monitor their blood pressure at home when starting cancer therapy that is known to increase blood pressure.

Recommendations for the diagnosis and management of cardiovascular adverse events during cancer treatment are provided. A common complication is a weakening of the heart muscle, known as left ventricular dysfunction, which can lead to a more severe weakening called heart failure. A typical cause is anthracycline chemotherapy such as doxorubicin, daunorubicin or epirubicin, which are used for breast cancer, acute leukemia, lymphoma and sarcoma. If cardiac dysfunction is detected during monitoring with ultrasound scans of the heart called echocardiograms and/or blood tests for cardiac injury or stress, cardiology and oncology teams are strongly encouraged to discuss the pros and cons of continuing or discontinuing cancer treatment.

Dr. Lyon said: "Several factors influence the decision to continue or discontinue therapy, including the extent and severity of the heart problem, how early or late the problem developed in the cancer treatment plan and how many further doses of treatment are proposed, the response of the cancer to treatment, the options for cardioprotection and their predicted benefit, the availability of alternative non-cardiotoxic cancer treatments, and the patient's preferences and concerns."

Monitoring is recommended for the first year after treatment in certain groups. This includes those who have developed a cardiac complication during treatment to assess whether the problem goes away or persists after the cancer drug is eliminated from the body. For some patients, this will result in an attempt to stop heart medications during cancer treatment, while for others lifelong heart treatment will be recommended. Another goal is to detect new heart problems, since with some cancer therapies, such as anthracyclines, most cardiovascular side effects are detected in the first 12 months after completion of treatment. Patients should maintain healthy lifestyle habits, report possible cardiac symptoms, and control blood pressure, diabetes, and high cholesterol.

Some patients require long-term monitoring for cardiovascular problems. These include survivors of childhood and young adult cancers who were treated with high-dose anthracycline chemotherapy and/or high-dose chest radiation therapy, adult cancer patients who experienced moderate or severe complications during treatment, survivors of leukemia, myeloma, or lymphoma who required a bone marrow transplant, and patients undergoing long-term cancer treatment that could potentially cause heart problems after years of treatment. Dr. Lopez-Fernandez said: "Long-term monitoring aims to detect and treat heart problems early to prevent serious complications in cancer survivors and avoid cardiovascular side effects in patients on long-term treatments."

The guideline was developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS).

Source:

European Society of Cardiology (ESC)

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