The toxicity of cancer drugs increasingly causing cardiovascular complications in patients.
Although anticancer treatments are effective in attacking cancerous cells, they also target healthy cells, which can cause issues such as cardiovascular disease.
In a new study published in European Heart Journal, a European Society of Cardiology task force launched a novel position paper that addresses the cardiac toxicity of these therapies.
“The good news is that cancer treatment has improved and more patients now survive,” said Patrizio Lancellotti, task force co-chairperson. “Unfortunately, there has been a progressive increase in cardiovascular events because radiation and anticancer drugs can be toxic to the heart. It is expected that among cancer survivors, cardiovascular disease will be the most important cause of death.”
The authors said that anticancer therapy is involved in 9 categories of cardiovascular complications: myocardial dysfunction and heart failure, arrhythmias, arterial hypertension, coronary artery disease, peripheral vascular disease and stroke, pulmonary hypertension, pericardial complication, and valvular disease.
In the paper, researchers outlined which patients are at risk, and how to detect and prevent potential side effects in each of the 9 types of complications. Furthermore, recommendations on how to treat and follow up patients who develop that type of cardiotoxicity are provided.
Prevention and treatment for cardiotoxicity involves cardioprotective drugs such as angiotensin converting enzyme (ACE) inhibitors, or a healthy lifestyle. To detect cardiotoxicity, physicians use ECG, cardiac imaging, and biomarkers.
“Aerobic exercise is considered a promising non-pharmacological strategy to prevent and/or treat chemotherapy-induced cardiotoxicity,” said study authors.
In terms of long-term surveillance of cancer survivors, researchers suggest that patients should be informed of their increased risk of cardiovascular disease at the outset of chemotherapy, as well as the support needed to make lifestyle changes. Additionally, all patients should report early signs and symptoms of cardiovascular disease.
Study authors noted that since under- or over-diagnosis of cardiovascular disease can at times result in failure to prevent adverse events or the interruption of anticancer treatment, physicians need to be cautious on when treatment should be discontinued.
“We need to be clear when it's a must to stop the treatment, when we should reduce the dose, or when we can continue with the therapy,” said Jose Luis Zamorano, task force chairperson. “This position paper provides guidance in this area.”
Lastly, the paper emphasized that establishing multidisciplinary teams to provide care for cancer patients and survivors is imperative, and should include cardiologists, nurses, oncologists, heart failure and imaging specialists.
“We hope the paper will increase awareness about heart disease in cancer patients and survivors and stimulate more research in this area,” Lancellotti said. “More information is needed on when to screen and monitor patients, and on the cardiovascular effects of new anticancer therapies.”