Balancing cancer treatment efficacy with the risk of cardiotoxicity and strategies for cardioprotection in adults

The long-term survival and overall prognosis of patients affected by malignancies has dramatically improved in the last several decades, primarily as a result of improvements in early detection of certain cancers and to advances of pharmacological cancer treatments. Unfortunately, the cardiovascular system is likely to be substantially affected by anticancer therapies. The clinical implications of cardiotoxicity are particularly relevant in those cancer patients in whom onset of cardiac dysfunction, even asymptomatic, seriously limits their subsequent therapeutic opportunities and negatively impacts their functional status. Hence, it is important to consider the balance of potential cardiac damage with ultimately cancer control. In addition to traditional cardiovascular disease risk factors, an integrated approach using serum cardiac biomarkers for early detection may help identify those patients at higher risk for cardiac adverse events. These biomarkers may enhance identification of those who could benefit from early preventive therapy or be utilized to help optimize cardioprotective therapy. Asymptomatic heart disease is common in patients being treated for cancer, and early identification and management of common cardiovascular disorders is of paramount importance. However, appropriate supporting clinical trial evidence for such an approach is still lacking, and established guidelines for the most appropriate method of the detection of cardiac dysfunction during cancer treatment is yet to be defined. Open and effective communication between various providers (oncologists, cardiologists, and primary care) as essential members of a care team is a crucial process for the best patient outcomes. Cardio-oncology, as a movement and clinical need, has made significant advances, but much work remains to be done.

Duke Scholars

Author Chiara Melloni Medicine, Cardiology