Circulation. 2023 Jul 18;148(3):297-308. doi: 10.1161/CIR.0000000000001158. Epub 2023 Jun 28.
Advances in cancer therapeutics have revolutionized survival outcomes in patients with cancer. However, cardiovascular toxicities associated with specific cancer therapeutics adversely affect the outcomes of patients with cancer. Recent studies have uncovered excess risks of these cardiotoxic events, especially in traditionally underrepresented populations. Despite advances in strategies to limit the risks of cardiovascular events among cancer survivors, relatively limited guidance is available to address the rapidly growing problem of disparate cardiotoxic risks among women and underrepresented patient populations. Previously decentralized and sporadic evaluations have led to a lack of consensus on the definitions, investigation, and potential optimal strategies to address disparate cardiotoxicity in contemporary cancer care (eg, with immunotherapy, biologic, or cytotoxic therapies) settings. This scientific statement aims to define the current state of evidence for disparate cardiotoxicity while proposing uniform and novel methodological approaches to inform the identification and mitigation of disparate cardio-oncology outcomes in future clinical trials, registries, and daily clinical care settings. We also propose an evidence-based integrated approach to identify and mitigate disparities in the routine clinical setting. This consensus scientific statement summarizes and clarifies available evidence while providing guidance on addressing inequities in the era of emerging anticancer therapies.
癌症治疗的进步彻底改变了癌症患者的生存结果。然而,特定癌症治疗相关的心血管毒性会对癌症患者的结局产生不利影响。最近的研究揭示了这些心脏毒性事件的风险增加,尤其是在传统上代表性不足的人群中。尽管在限制癌症幸存者心血管事件风险的策略方面取得了进展,但针对女性和代表性不足的患者群体中迅速增长的心脏毒性风险差异问题,可用的指导相对有限。以前分散和零星的评估导致在定义、调查以及在当代癌症治疗(例如免疫治疗、生物治疗或细胞毒性治疗)环境中解决心脏毒性差异的潜在最佳策略方面缺乏共识。本科学声明旨在定义当前心脏毒性差异的证据状况,同时提出统一和新颖的方法学方法,为未来临床试验、登记处和日常临床护理环境中识别和减轻心脏肿瘤学结局的差异提供信息。我们还提出了一种基于证据的综合方法,以在常规临床环境中识别和减轻差异。本共识科学声明总结并澄清了现有证据,同时为新兴抗癌疗法时代的公平问题提供了指导。