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CHAPTER SUMMARY AND CENTRAL ILLUSTRATION

Chapter Summary

This chapter discusses the cardiovascular complications of cancer therapies and tumors of the cardiovascular system. The treatment of cancer has undergone dramatic changes in this millennium. Many cancer patients have been cured, gone into remission, or have had their survival significantly extended by new therapies. Cancer therapies, including chemotherapeutics, targeted therapy, cancer immunotherapy, and radiation treatment, can affect the cardiovascular system (see Fuster and Hurst's Central Illustration). Thus, it is important to identify risk factors, monitor potential cardiovascular complications, and to administer cardioprotective treatments to cancer patients from the inception of diagnosis and throughout cancer therapy. New advances in deciphering the pathogenesis of anthracycline-induced cardiotoxicity may lead to the development of new cardioprotective strategies. Early identification and treatment of cardiovascular manifestations have been shown to prevent conversion of subclinical cardiotoxicity to heart failure or accelerated vascular diseases. With the introduction of novel cancer therapies, increased vigilance in detection of new cardiovascular complications is essential to improve delivery of optimal cancer therapy and to prevent long-term cardiovascular toxicity of cancer therapy.

eFig 74-01 Chapter 74: Cardiovascular Disease in Patients with Cancer and Cardiovascular Complications of Cancer Therapies

INTRODUCTION AND EPIDEMIOLOGY

The treatment of cancer has undergone a dramatic change in this millennium. Many cancer patients have been cured, gone into remission, or have had their survival significantly extended by new therapies. As of January 1, 2016, more than 16.9 million Americans survived cancer and this number is expected to reach 22.1 million by 2230.1

Cancer patients may develop cardiovascular complications as a result of cancer therapy or as a result of progression of their underlying cardiac conditions. This may manifest during or immediately following cancer therapy. Damage to the cardiovascular system associated with cancer therapies can also be subclinical and manifest later in life. In the Childhood Cancer Survivor Study, 23,462 5-year cancer survivors were followed for more than 20 years.2 Cumulative incidences of heart failure, coronary artery disease (CAD), pericardial disease, and arrhythmia are increased in cancer survivors compared to their siblings. Due to reductions in the dose of cardiac radiation, the cumulative incidence of CAD was lowered in patients treated after 1990 compared to earlier patient cohorts. However, new cardiovascular complications have been identified with the introduction of new cancer therapies.

The field of cardio-oncology, or onco-cardiology, has developed as a response to a rise in the incidence of cardiovascular complications caused by newer cancer therapies. Oncologists have faced the challenges of anthracycline-induced cardiotoxicity for more than 50 years, with only occasional cardiology consultation. However, cardiology services devoted to serving cancer patients emerged in the early 2000s. Many cancer centers and tertiary care hospitals have established cardio-oncology services where cardiologists work closely together with oncologists to manage cardiovascular complications during cancer treatments. Early detection of ...

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