Michael G. Fradley, MD
In patients with cancer, improvements in survival have opened the door to broader consideration of the long-term effects of treatment and how best to manage them. Cardiotoxicity is 1 such adverse event (AE) that is getting more attention among oncologists, as evidenced by a sudden rise in meetings and educational events devoted to this aspect of care. Statistics help explain this growing attention to downstream effects of treatment. An estimated 15.5 million cancer survivors are in the United States, and more than 60% of cancer survivors are alive 5 years after diagnosis. Even at 10 years, survivorship is about 40% overall.1-3
As patients live longer following cancer diagnosis and treatment, quality of life concerns and moderation of AEs related to treatment have grown in importance. Simply put, cardiotoxicity has become a facet of cancer survivorship that oncologists must learn to manage and, ideally, prevent (Tables 14,25-8
Fortunately, physicians do not have to do it alone, thanks to the emerging subspecialty of cardio-oncology. Cardiologists who focus on the cardiotoxic effects of anticancer agents can provide guidance on cardiac-related toxicities, diagnoses, AEs and treatment strategies; this dovetails with oncologists’ core expertise. Now an integral part of academic medical centers, cardio-oncologists are finding their way into the community practice setting. “We really want to change the care paradigm to be more collaborative, to emphasize that oncologists and cardiologists need to be interacting together to provide good care,” said Michael G. Fradley, MD, an attending cardiologist and electrophysiologist at Moffitt Cancer Center in Tampa, Florida. “Because so many patients are living longer and surviving their disease, we don’t want them to have major cardiac issues down the road.”
The National Cancer Institute defines cardiotoxicity very broadly as “toxicity that affects the heart,” which various organizations refine as a host of diseases and conditions that result from treatment with a variety of oncologic drugs. Major medical associations including the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology, the National Comprehensive Cancer Network (NCCN), the International Society for Geriatric Oncology, and the American Heart Association have begun to formulate recommendations and guidelines that address various aspects of cardiotoxicity.
In a June report on guidelines for cardiovascular toxicity in cancer survivors, Carlyn Tan, MD, and Crystal S. Denlinger, MD, noted that each guideline has a different focus and intended usership. Some focus on pre- and on-treatment care, and others address posttreatment surveillance and management.9
Although these guidelines offer helpful recommendations for specific populations and circumstances, their limited scope makes it challenging for oncologists to apply recommendations across the broad spectrum of clinical practice.