By Dr. Eric Oligino
Director, Cardio-Oncology Program, Hartford HealthCare Cancer Institute
Over recent decades, advances in cancer therapies have translated into a rising population of cancer survivors estimated to reach 19 million in the United States alone by 2024.
Similarly, novel treatment options continue to reduce the morbidity and mortality associated with cardiovascular disease. Despite great strides in both arenas, cardiovascular disease and cancer remain the two leading causes of death in the United States, accounting for approximately 46 percent of all incidences.
Not surprisingly, these trends have led to a greater number of patients with cardiovascular disease and risk factors being treated for cancer. And widely used cancer therapies have known cardiovascular toxicities affecting those even without pre-existing heart disease. Toxicities include, but are not limited to, cardiac dysfunction and heart failure, arrhythmias, valvular disease, accelerated coronary disease and pericardial disease. Coexisting cancer and cardiovascular disease leads to complex management decisions that extend beyond the boundaries of traditional medicine specialties. A new discipline termed “Cardio-Oncology” has formed in response to this growing clinical need.
A Cardio-Oncology team consists of dedicated professionals across multiple disciplines who provide specialized care to cancer patients throughout all treatment phases. Screening, preventing, and treating cardiotoxicities of cancer therapies require specialized knowledge to balance risks and benefits. Importantly, the scope of Cardio-Oncology extends beyond cardiotoxicity and encompasses comprehensive cardiovascular care throughout survivorship. Long after the active cancer treatment phase is complete, Cardio-Oncology aims to maximize cardiovascular health.
Traditional cardiac risk factors, namely hypertension, diabetes, hyperlipidemia and smoking, need to be aggressively controlled in survivorship. In women with breast cancer, weight gain and decreased physical activity are recognized consequences of treatment and the disease itself. A recent meta-analysis found that pre-diagnosis and post-diagnosis physical activity were associated with a lower mortality and breast cancer recurrence. Cardio-Oncology programs emphasize the American Heart Association’s recommendation of at least 30 minutes of moderate-intense aerobic physical activity 5 days each week.
The European Society of Cardiology recently published a position paper detailing the rationale, organization, and implementation of Cardio-Oncology programs. Multiple professional societies, including the American Heart Association, have published guidelines to minimize the heterogeneous approach of current clinical practices.
For example, anthracyclines are common anti-cancer agents used against multiple diseases including breast cancer and hematologic malignancies. These agents are known to carry a risk of cardiac dysfunction and heart failure, and in fact, the origins of Cardio-Oncology date back to the 1960s when these complications were first recognized. As a result, a baseline assessment of cardiac function, most commonly by an echocardiogram, is required before initiating an anthracycline-based regimen. But follow-up assessments are now recommended immediately following and six months after completing treatment. Adoption of these new guidelines has been slow, particularly in settings without a dedicated Cardio-Oncology team.
Hartford HealthCare’s Cardio-Oncology Program incorporates the most cutting-edge approach to the cardiovascular health of cancer patients throughout all treatment phases. Not all patients require a formal assessment, but specialists are readily available to address the broad range of issues that may arise. Transitioning from the treatment phase into survivorship is an opportune time to determine if a Cardio-Oncology consultation is right for you.
Dr. Eric Oligino, is the director of the Cardio-Oncology Program at the Hartford HealthCare Cancer Institute.