Rationale for setting up a cardio-oncology unit: our experience at Mayo Clinic

Abstract

Background: The diagnosis and management of cardiovascular complications have become a clinical concern for oncologists, cardiologists, surgeons, interventional radiologists, radiation therapy physicians, internists, nurses, pharmacists, administrators, and all the stakeholders involved in the care of cancer patients. Anticancer therapies have extended the lives of patients with cancer, but for some this benefit is attenuated by adverse cardiovascular effects.Methods: This review article aims to provide an overview of the rationale of setting up a cardio-oncology unit and reflect on our own experience establishing this service, and conclude with some fundamental aspects of consideration for evaluation and management of patients with cancer and cardiovascular diseases. Results: Cardiotoxicity can lead to congestive heart failure and cardiac death. In fact, chemotherapy-related cardiac dysfunction may carry one of the worst prognoses of all types of cardiomyopathies, and has a profound impact on morbidity and mortality in oncology patients. Other complex clinical situations involve cancer patients who might benefit from a highly curative drug in terms of cancer survival but face limitations of its administration because of concomitant cardiovascular diseases. Indeed, the balance between the benefits and risks of the cancer therapy regimen in the context of the cardiovascular status of the individual patient can sometimes be extraordinarily challenging. A subspecialty with a multidisciplinary integrative approach between oncologists, hematologists, cardiologists, among others has thus emerged to address these issues, termed cardio-oncology. Cardio-oncology addresses the spectrum of prevention, detection, monitoring and treatment of cancer patients with cardiovascular diseases, or at risk for cardiotoxicity, in a multidisciplinary manner. In this field, cardiologists assist oncologists and hematologists with cardiovascular recommendations. This can be mediated through e-consultations or face-to-face evaluations. Conclusion: Cardio-oncology is a subspecialty that assists in the overall care of cancer patients with and without cardiovascular disease in an interdisciplinary fashion. We believe that this partnership of sharing responsibilities and experiences among health-care team members can potentially decrease cancer therapeutics-related cardiovascular complications and improve clinical outcomes.

Prevention, Monitoring, and Management of Cardiac Dysfunction in Patients with Metastatic Breast Cancer

“…The need to provide optimal cancer therapy while minimizing the impact on cardiovascular health has led to the creation of cardio‐oncology . The origins of cardio‐oncology date back to the late 1960s, when the cardiac effects of anthracyclines were initially recognized . The field has rapidly evolved during the past decade, becoming a formal subspecialty with dedicated units now within major health care centers .…”

“…The origins of cardio‐oncology date back to the late 1960s, when the cardiac effects of anthracyclines were initially recognized . The field has rapidly evolved during the past decade, becoming a formal subspecialty with dedicated units now within major health care centers . The International Cardio‐Oncology Society was established in 2009 , the ESC created the Council of Cardio‐Oncology in 2018 , and the American College of Cardiology now has a Cardio‐Oncology Section .…”

Cardiotoxicity and cardiovascular disease risk assessment for patients receiving breast cancer treatment

“…nausea and lethargy). However, our results would indicate an opportunity for cardio-oncology educational interventions similar to models that are being researched internationally [28,30,31].…”

“…The aim of this study was to produce a standardised, comprehensive approach to assessing the risk of cardiotoxicity, which included assessment and measurement of CVD risk and lifestyle factors that may indicate undiagnosed CVD prior to cancer treatment. From a nursing point of view, as many risk factors for cancer and CVD are the same, this questionnaire could create a 'teaching moment' and an opportunity to introduce risk management and lifestyle education as part of cancer treatment [28,29]. Future studies exploring the role of patient education as a strategy to change behaviour and increase engagement in care are warranted.…”

Insuficiência Cardíaca no Paciente Oncológico: Preditores de Risco

“…Esta varia conforme os fatores de risco do paciente e da QT proposta, promovendo pontuações de acordo com cada medicação e fator de risco, graduando-os em riscos para o desenvolvimento de CDTX. Assim, os pacientes sofrerão avaliações mais frequentes conforme as pontuações atingidas (Quadro 1) 4 .…”