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Summary

This chapter discusses the diagnosis and management of cardiovascular disease in patients with cancer. Chemotherapy-induced cardiotoxicity is a growing health issue, in part because the incidence of cancers necessitating aggressive chemotherapy has been increasing, despite the overall incidence of cancer declining since the early 2000s, and also because of increasing longevity of cancer survivors (see accompanying Hurst’s Central Illustration). Radiation therapy can also exert adverse effects on the heart; the pericardium is the cardiac structure most sensitive to irradiation; but the myocardium, heart valves, conduction system, and cardiac vasculature can also be affected. The various acute and chronic cardiovascular complications of cancer therapy include acute coronary syndromes, myocarditis, pericarditis, fluctuations in blood pressure, arrhythmias, thromboembolism, accelerated coronary artery disease, valvulopathy, and heart failure. Many of these conditions can also be cardiovascular manifestations of the cancer itself. Early detection and management of these cardiovascular complications improve patient outcomes. Dedicated cardio-oncology clinics are being established to provide specialized cardiac care to cancer patients.

eFig 101-01

Hurst's Central Illustration: The Perfect Storm for Cardiovascular Disease in Patients with Cancer.

The combination of the increasing incidence of cancers necessitating aggressive chemotherapy and the increased longevity of cancer survivors means that chemotherapy-induced cardiotoxicity is a growing issue. Research into strategies to prevent or reduce the risk of chemotherapy-induced cardiotoxicity is being actively undertaken, and dedicated cardio-oncology clinics are being established to provide specialized cardiac care to cancer patients.

INTRODUCTION AND EPIDEMIOLOGY

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 either be cured of their disease or have their disease stabilized by maintenance therapy. Although the overall rate of cancer incidence has declined since the early 2000s,1 cancers necessitating aggressive chemotherapy, including melanoma, non-Hodgkin lymphoma, leukemia, and those of the pancreas and esophagus have been on the rise. Accompanying this trend, the length of cancer survival has increased for all cancers combined. The 5-year survival rate for all cancers combined improved from 66.7% in 2003 to 68% in 2009.1 This implies that cancer survivors now live longer, allowing the manifestation of potential cardiac side effects of chemotherapeutic agents as well as the age-related increase in the risk of cardiovascular disease.

For individuals free of cardiovascular disease at 50 years of age, more than half of men and nearly 40% of women will develop cardiovascular disease during their remaining lifetime. Other than the extended survival of cancer patients and the aging population, there has been an increase in the recognition of chemotherapy-induced cardiotoxicity, adding to the linkage between patients with cancer and their risk for cardiovascular diseases. In addition, some patients with cancer may be at a higher risk for cardiovascular complications as compared with the general population.2 Multiple classes of potentially cardiotoxic anticancer agents are ...

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