Chapter 90

With the advent of more effective cancer treatments and the increasing likelihood of an earlier cancer diagnosis, patients with many forms of cancer can expect to be either cured of their disease or have their disease stabilized by maintenance therapy. Many forms of cancer should now be thought of as chronic and slowly progressive diseases. Regardless of whether the patient is in the active treatment stage, the chronic maintenance stage, or complete remission cardiovascular specialists are assuming a much greater role in the management of cancer patients. In the active treatment phase, the cardiovascular consultant should manage the acute and chronic cardiovascular complications of cancer therapy such as blood pressure fluctuations, acute coronary syndromes (ACS), congestive heart failure, thromboembolism, and pericardial effusion. Also in this phase, patients who are at high risk for cardiovascular complications during complex cancer surgery can be identified and cardiovascular complications managed in the perioperative period. In the chronic maintenance stage, cardiologists are frequently asked to diagnose potential cardiovascular complications of cancer therapy or manage other developing risk factors for vascular disease. With the development of specific targeted cancer therapy, such as antiangiogenesis therapy and vascular disrupting agents, new cardiovascular complications have emerged.

The incidence of patients diagnosed with both heart disease and cancer is rising, primarily because of the aging population and the length of time that cancer patients survive. Accordingly, cardiologists are increasingly involved in the care of patients with concomitant cardiovascular problems and cancer.

There are several considerations that do not pertain to the care of patients without cancer. A cardiovascular symptom that occurs during cancer treatment may be caused by the administered agent or agents, whether it is a result of an underlying cardiovascular condition or of a progressive malignancy. Frequently, a combination of chemotherapy agents is used, adding to the complexity in determining which drug is responsible for a particular cardiac problem; causal relationships between particular agents and a cardiovascular symptom may not yet be firmly established.

Cardiologists must make every effort to optimize the management of any underlying cardiovascular risk factor such as hypercholesterolemia or hypertension and minimize any thrombogenic condition. Cardiologists must also manage cardiovascular complications that arise acutely as the result of cancer treatment. Also, long-term follow-up of cancer patients with regard to evolving cardiac dysfunction is an important part of such surveillance. This chapter discusses the classic and emerging cardiovascular complications of cancer therapy and describes suggested patterns for managing cancer-related cardiac issues. For this chapter, the cardiotoxicities of chemotherapy and antibody-based therapy are grouped by symptom clusters: heart failure, ischemia, blood pressure changes, and dysrhythmia (Table 90–1). This organization allows for the development of useful guidelines when dealing with cancer patients who have cardiovascular symptoms.1-4

Table 90–1. Cardiotoxicity of Chemotherapy and Antibody-Based Therapy

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