What Does a Cardio-oncology Service Offer to the Oncologist and the Haematologist?

Abstract

Cardio-oncology is an emerging subspecialty arising from the need for multidisciplinary collaboration to address the increasing prominence of cardiovascular disease (CVD) among cancer patients. This overview outlines the case for establishing cardio-oncology services and defines the ways in which these services benefit cancer patients. The primary objective of cardio-oncology is to manage CVDs in order to allow cancer patients to complete the best cancer treatments safely and with minimal interruption. In the decades since the first discovery of heart failure induced by anthracycline chemotherapy, both cardiovascular and oncological science have advanced considerably. Cardio-oncology services aim to bring together expertise from these two fast moving fields in order to provide optimal evidence-based care for cancer patients with CVDs. Here we discuss the basis of cardio-oncology services by presenting their rationale and key components, as well as their essential roles in education, training and research. At each stage of the cancer care pathway, a cardio-oncology service can add value by ensuring cancer patients have timely access to specialist care backed up by cutting edge diagnostic tools and treatment options, as well as holistic supports. We highlight areas of recent and upcoming developments in the field that are likely to change established clinical practice. Improved cardiac imaging modalities can detect chemotherapy-related cardiac dysfunction earlier and are also essential for the prompt diagnosis of an expanding range of cardiovascular effects complicating newer cancer therapeutics, such as immune checkpoint inhibitors and other targeted therapies. Modern cancer therapy has dramatically improved cancer survival and as such CVD is becoming one of the principal determinants of overall outcome for cancer patients. A dedicated cardio-oncology service can facilitate the optimisation of cardiovascular treatment and enable the completion of cancer therapy. A multidisciplinary collaborative approach is key to achieving these objectives.

Risk and Management of Patients with Cancer and Heart Disease

“…As stated for other populations of patients, exercise training for cancer patients must be individualized [ 69 ] and take account of the patient’s previous history of exercise, their current fitness state, and their motivation and preferences.…”

Cardiotoxicity Induced by Immune Checkpoint Inhibitors: What a Cardio-Oncology Team Should Know and Do

“…The importance of the close collaboration of the oncologist with a cardiologist specialist in managing cancer patients has become clear, considering the documented cardiotoxicity of many chemotherapy drugs and target therapy agents. The main purpose of a multidisciplinary cardio-oncology team is to ensure that the patient receives the best cancer treatment with the lowest risk of cardiovascular events [ 90 ].…”

Personalizing Heart Failure Care to the Patient With Cancer

“…The study of Fradley et al (2021) providing inter-disciplinary approach with motivational interviewing and empathy via telephone calls, showed a positive impact on the mental health of 33 women with breast cancer undergoing chemo-therapy [30]. Furthermore, with scarce evidence on interventional studies including cardio-oncology patients, cohort studies reveal the importance of lifestyle modification and exercise on minimizing cardiovascular events in cancer survivors [31][32][33][34][35]. A recent meta-synthesis, exploring patients with heart failure and comorbidities needs revealed their need for continuing support.…”

“…Patient empowerment helps increase patient awareness as well as encourage mutual trust and open communication between patients and health professionals (HPs) [36]. Patients need care that focuses on their ongoing needs and adapts as these needs change according to the passage of time, the reaction to their therapy, their socio-economic factors, their environment, the health care system, and the possibilities of its application in everyday life and health care needs through shared-decision making [12,28,31,35,36]. That creates a significant challenge for clinicians to determine which patients will develop cardiotoxicity or are in high risk, develop inter-disciplinary programs to early identify and detect such cases and successfully manage cardio-oncology patients to minimize CV events and maintain HR-QoL.…”