Department of Cardiology, University Hospital Ramón y Cajal, CiberCV, Madrid, Spain.
Cardiovascular Safety Centre of Excellence, Patient Safety, CMO Organization, AstraZeneca, Gothenburg, Sweden.
Eur J Heart Fail. 2020 Dec;22(12):2290-2309. doi: 10.1002/ejhf.1985. Epub 2020 Oct 2.
Advances in cancer treatments have improved clinical outcomes, leading to an increasing population of cancer survivors. However, this success is associated with high rates of short- and long-term cardiovascular (CV) toxicities. The number and variety of cancer drugs and CV toxicity types make long-term care a complex undertaking. This requires a multidisciplinary approach that includes expertise in oncology, cardiology and other related specialties, and has led to the development of the cardio-oncology subspecialty. This paper aims to provide an overview of the main adverse events, risk assessment and risk mitigation strategies, early diagnosis, medical and complementary strategies for prevention and management, and long-term follow-up strategies for patients at risk of cancer therapy-related cardiotoxicities. Research to better define strategies for early identification, follow-up and management is highly necessary. Although the academic cardio-oncology community may be the best vehicle to foster awareness and research in this field, additional stakeholders (industry, government agencies and patient organizations) must be involved to facilitate cross-discipline interactions and help in the design and funding of cardio-oncology trials. The overarching goals of cardio-oncology are to assist clinicians in providing optimal care for patients with cancer and cancer survivors, to provide insight into future areas of research and to search for collaborations with industry, funding bodies and patient advocates. However, many unmet needs remain. This document is the product of brainstorming presentations and active discussions held at the Cardiovascular Round Table workshop organized in January 2020 by the European Society of Cardiology.
癌症治疗的进展改善了临床结果,导致癌症幸存者的人数不断增加。然而,这种成功伴随着短期和长期心血管(CV)毒性的高发生率。癌症药物的数量和种类以及 CV 毒性类型使得长期护理成为一项复杂的任务。这需要多学科的方法,包括肿瘤学、心脏病学和其他相关专业的专业知识,并导致了心脏肿瘤学亚专业的发展。本文旨在概述主要不良事件、风险评估和风险缓解策略、早期诊断、预防和管理的医学和补充策略,以及有癌症治疗相关心脏毒性风险的患者的长期随访策略。需要进行研究以更好地确定早期识别、随访和管理的策略。尽管学术心脏肿瘤学界可能是促进该领域意识和研究的最佳载体,但还必须涉及其他利益相关者(行业、政府机构和患者组织),以促进跨学科互动,并有助于心脏肿瘤学试验的设计和资金。心脏肿瘤学的总体目标是协助临床医生为癌症患者和癌症幸存者提供最佳护理,深入了解未来的研究领域,并寻求与行业、资助机构和患者权益倡导者的合作。然而,仍有许多未满足的需求。本文档是 2020 年 1 月欧洲心脏病学会组织的心血管圆桌会议研讨会的头脑风暴演示和积极讨论的产物。