1
|
Albulushi A, Al Balushi A, Shahzad M, Al Bulushi I, Al Lawati H. Navigating the crossroads: cardiometabolic risks in cancer survivorship - a comprehensive review. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:51. [PMID: 39138547 PMCID: PMC11321223 DOI: 10.1186/s40959-024-00254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024]
Abstract
The landscape of cancer survivorship is increasingly populated by individuals facing a spectrum of cardiometabolic risks, attributed to both their oncological history and treatment regimens. This manuscript synthesizes findings from various studies, highlighting the prevalence of traditional risk factors-hypertension, dyslipidemia, diabetes-as well as emergent concerns like obesity and metabolic syndrome among survivors. The impact of demographic variables, specific cancer types, and treatment modalities on cardiometabolic health is explored. Through a lens of multidisciplinary management and future research directives, we advocate for an integrative approach to cardiometabolic health in cancer survivors, aiming to ensure their victory over cancer extends into long-term well-being. Furthermore, we discuss the outcome implications of these cardiometabolic risk factors on cardiovascular disease development, future cardiovascular events, and overall survival, supported by studies showing improved outcomes through exercise and risk factor control.
Collapse
Affiliation(s)
- Arif Albulushi
- Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman.
- Advanced Heart Failure & Transplant Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman.
| | - Aisha Al Balushi
- National Hyperbaric Medicine Centre, The Royal Hospital, Muscat, Oman
| | - Muhhamed Shahzad
- Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| | - Ismail Al Bulushi
- Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| | - Hatim Al Lawati
- Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| |
Collapse
|
2
|
Albulushi A, Balushi AA, Shahzad M, Bulushi IA, Lawati HA. Navigating the crossroads: cardiometabolic risks in cancer survivorship - a comprehensive review. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:36. [PMID: 38879583 PMCID: PMC11179285 DOI: 10.1186/s40959-024-00240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/10/2024] [Indexed: 06/19/2024]
Abstract
The landscape of cancer survivorship is increasingly populated by individuals facing a spectrum of cardiometabolic risks, attributed to both their oncological history and treatment regimens. This manuscript synthesizes findings from various studies, highlighting the prevalence of traditional risk factors-hypertension, dyslipidemia, diabetes-as well as emergent concerns like obesity and metabolic syndrome among survivors. The impact of demographic variables, specific cancer types, and treatment modalities on cardiometabolic health is explored. Through a lens of multidisciplinary management and future research directives, we advocate for an integrative approach to cardiometabolic health in cancer survivors, aiming to ensure their victory over cancer extends into long-term well-being.
Collapse
Affiliation(s)
- Arif Albulushi
- Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman.
| | - Aisha Al Balushi
- National Hyperbaric Medicine Centre, The Royal Hospital, Muscat, Oman
| | - Muhhamed Shahzad
- Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| | - Ismail Al Bulushi
- Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| | - Hatim Al Lawati
- Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| |
Collapse
|
3
|
Weaver KE, Dressler EV, Smith S, Nightingale CL, Klepin HD, Lee SC, Wells BJ, Hundley WG, DeMari JA, Price SN, Foraker RE. Cardiovascular health assessment in routine cancer follow-up in community settings: survivor risk awareness and perspectives. BMC Cancer 2024; 24:158. [PMID: 38297229 PMCID: PMC10829276 DOI: 10.1186/s12885-024-11912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Guidelines recommend cardiovascular risk assessment and counseling for cancer survivors. For effective implementation, it is critical to understand survivor cardiovascular health (CVH) profiles and perspectives in community settings. We aimed to (1) Assess survivor CVH profiles, (2) compare self-reported and EHR-based categorization of CVH factors, and (3) describe perceptions regarding addressing CVH during oncology encounters. METHODS This cross-sectional analysis utilized data from an ongoing NCI Community Oncology Research Program trial of an EHR heart health tool for cancer survivors (WF-1804CD). Survivors presenting for routine care after potentially curative treatment recruited from 8 oncology practices completed a pre-visit survey, including American Heart Association Simple 7 CVH factors (classified as ideal, intermediate, or poor). Medical record abstraction ascertained CVD risk factors and cancer characteristics. Likert-type questions assessed desired discussion during oncology care. RESULTS Of 502 enrolled survivors (95.6% female; mean time since diagnosis = 4.2 years), most had breast cancer (79.7%). Many survivors had common cardiovascular comorbidities, including high cholesterol (48.3%), hypertension or high BP (47.8%) obesity (33.1%), and diabetes (20.5%); 30.5% of survivors received high cardiotoxicity potential cancer treatment. Less than half had ideal/non-missing levels for physical activity (48.0%), BMI (18.9%), cholesterol (17.9%), blood pressure (14.1%), healthy diet (11.0%), and glucose/ HbA1c (6.0%). While > 50% of survivors had concordant EHR-self-report categorization for smoking, BMI, and blood pressure; cholesterol, glucose, and A1C were unknown by survivors and/or missing in the EHR for most. Most survivors agreed oncology providers should talk about heart health (78.9%). CONCLUSIONS Tools to promote CVH discussion can fill gaps in CVH knowledge and are likely to be well-received by survivors in community settings. TRIAL REGISTRATION NCT03935282, Registered 10/01/2020.
Collapse
Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sydney Smith
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Heidi D Klepin
- Section on Hematology-Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Simon Craddock Lee
- Department of Population Health, University of Kansas Medical Center, Mail Stop 1008, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - W Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, 417 N 11th St 4th Floor, Richmond, VA, 23219, USA
| | - Joseph A DeMari
- Section on Gynecologic Oncology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sarah N Price
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Randi E Foraker
- Department of Medicine, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., MSC 8066-22-6602, St. Louis, MO, 63110, USA
| |
Collapse
|
4
|
Hashibe M, Wei M, Lee CJ, Tao R, Koric A, Wang J, Daud A, Tay D, Shen J, Lee YCA, Chang CPE. Incident Cardiovascular Disease Risk among Older Asian, Native Hawaiian and Pacific Islander Breast Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2024; 33:126-135. [PMID: 37843411 PMCID: PMC10842246 DOI: 10.1158/1055-9965.epi-23-0679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/11/2023] [Accepted: 10/12/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Cardiotoxicity among breast cancer survivors is associated with chemotherapy and radiation therapy. The risk of cardiovascular disease (CVD) among Asian, Native Hawaiian and Pacific Islander (ANHPI) breast cancer survivors in the United States is unknown. METHODS We used the SEER-Medicare linked database to estimate the risk of CVD among older breast cancer survivors. International Classification of Disease diagnosis codes were used to identify incident CVD outcomes. Cox proportional hazards models were used to estimate HRs and 95% confidence intervals (CI) comparing ANHPI with Non-Hispanic White (NHW) patients with breast cancer for CVD, and among ANHPI race and ethnicity groups. RESULTS A total of 7,122 ANHPI breast cancer survivors and 21,365 NHW breast cancer survivors were identified. The risks of incident heart failure and ischemic heart disease were lower among ANHPI compared with NHW breast cancer survivors (HRheart failure, 0.72; 95% CI, 0.61-0.84; HRheart disease, 0.74; 95% CI, 0.63-0.88). Compared with Japanese patients with breast cancer, Filipino, Asian Indian and Pakistani, and Native Hawaiian breast cancer survivors had higher risks of heart failure. ischemic heart disease and death. Among ANHPI breast cancer survivors, risk factors for heart failure included older age, higher comorbidity score, distant cancer stage and chemotherapy. CONCLUSIONS Our results support heterogeneity in CVD outcomes among breast cancer survivors among ANHPI race and ethnicity groups. Further research is needed to elucidate the disparities experienced among ANHPI breast cancer survivors. IMPACT Filipino, Asian Indian and Pakistani, and Native Hawaiian patients with breast cancer had higher risks of heart failure, ischemic heart disease and death among ANHPI patients with breast cancer.
Collapse
Affiliation(s)
- Mia Hashibe
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah
| | - Mei Wei
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Oncology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Catherine J. Lee
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Hematology & Hematologic Malignancies, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Randa Tao
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Alzina Koric
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jing Wang
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Anees Daud
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Djin Tay
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Jincheng Shen
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - Yuan-chin A. Lee
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Chun-Pin E. Chang
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
5
|
Zhang S, Liu L, Shi S, He H, Shen Q, Wang H, Qin S, Chang J, Zhong R. Bidirectional Association Between Cardiovascular Disease and Lung Cancer in a Prospective Cohort Study. J Thorac Oncol 2024; 19:80-93. [PMID: 37703998 DOI: 10.1016/j.jtho.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION The study aimed to prospectively investigate the bidirectional association between cardiovascular disease (CVD) and lung cancer, and whether this association differs across genetic risk levels. METHODS This study prospectively followed 455,804 participants from the United Kingdom Biobank cohort who were free of lung cancer at baseline. Cox proportional hazard models were used to estimate the hazard ratio (HR) for incident lung cancer according to CVD status. In parallel, similar approaches were used to assess the risk of incident CVD according to lung cancer status among 478,756 participants free of CVD at baseline. The bidirectional causal relations between these conditions were assessed using Mendelian randomization analysis. Besides, polygenic risk scores were estimated by integrating genome-wide association studies identified risk variants. RESULTS During 4,007,477 person-years of follow-up, 2006 incident lung cancer cases were documented. Compared with participants without CVD, those with CVD had HRs (95% confidence interval [CI]) of 1.49 (1.30-1.71) for NSCLC, 1.80 (1.39-2.34) for lung squamous cell carcinoma (LUSC), and 1.25 (1.01-1.56) for lung adenocarcinoma (LUAD). After stratification by smoking status, significant associations of CVD with lung cancer risk were observed in former smokers (HR = 1.44, 95% CI: 1.20-1.74) and current smokers (HR = 1.38, 95% CI: 1.13-1.69), but not in never-smokers (HR = 0.98, 95% CI: 0.60-1.61). In addition, CVD was associated with lung cancer risk across each genetic risk level (pheterogeneity = 0.336). In the second analysis, 32,974 incident CVD cases were recorded. Compared with those without lung cancer, the HRs (95% CI) for CVD were 2.33 (1.29-4.21) in NSCLC, 3.66 (1.65-8.14) in LUAD, and 1.98 (0.64-6.14) in LUSC. In particular, participants with lung cancer had a high risk of incident CVD at a high genetic risk level (HR = 3.79, 95% CI: 1.57-9.13). No causal relations between these conditions were observed in Mendelian randomization analysis. CONCLUSIONS CVD is associated with an increased risk of NSCLC including LUSC and LUAD. NSCLC, particularly LUAD, is associated with a higher CVD risk. Awareness of this bidirectional association may improve prevention and treatment strategies for both diseases. Future clinical demands will require a greater focus on cardiac oncology.
Collapse
Affiliation(s)
- Shanshan Zhang
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lei Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shanshan Shi
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Heng He
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, People's Republic of China
| | - Qian Shen
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Haoxue Wang
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shifan Qin
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jiang Chang
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Rong Zhong
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
| |
Collapse
|
6
|
Nielsen S, O'Neil B, Chang CP, Mark B, Snyder J, Deshmukh V, Newman M, Date A, Galvao C, Henry NL, Lloyd S, Hashibe M. Determining the association of rurality and cardiovascular disease among prostate cancer survivors. Urol Oncol 2023; 41:429.e15-429.e23. [PMID: 37455231 PMCID: PMC10787808 DOI: 10.1016/j.urolonc.2023.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/25/2023] [Accepted: 06/18/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Rural disparities in prostate cancer survivorship and cardiovascular disease remain. Prostate cancer treatment also contributes to worse cardiovascular disease outcomes. Our objective was to determine whether rural-urban differences in cardiovascular outcomes contribute to disparities in prostate cancer survivorship. MATERIALS AND METHODS Data were collected from the Utah Population Database. Rural and urban prostate cancer survivors were matched by diagnosis year and age. Cox proportional hazards models were used to estimate hazard ratios for cardiovascular disease (levels 1-3) based on rural-urban classification, while controlling for demographic and socioeconomic characteristics. We identified 3,379 rural and 16,253 urban prostate cancer survivors with a median follow-up of 9.3 years. RESULTS Results revealed that rural survivors had a lower risk of hypertension (HR 0.90), diseases of arteries (HR 0.92), and veins (HR 0.92) but a higher risk of congestive heart failure (HR 1.17). Interactions between level 2 cardiovascular diseases and rural/urban status, showed that diseases of the heart had a distinct between-group relationship for all-cause (P = 0.005) and cancer-specific mortality (P = 0.008). CONCLUSIONS This study revealed complex relationships between rural-urban status, cardiovascular disease, and prostate cancer. Rural survivors were less likely to be diagnosed with screen-detected cardiovascular disease but more likely to have heart failure. Further, the relationship between cardiovascular disease and survival was different between rural and urban survivors. It may be that our findings underscore differences in healthcare access where rural patients are less likely to be screened for preventable cardiovascular disease and have worse outcomes when they have a major cardiovascular event.
Collapse
Affiliation(s)
| | - Brock O'Neil
- Division of Urology, University of Utah, Salt Lake City, UT.
| | - Chun-Pin Chang
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT
| | - Bayarmaa Mark
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT
| | - Vikrant Deshmukh
- Department of Health Sciences, University of Utah, Salt Lake City, UT
| | - Michael Newman
- Department of Health Sciences, University of Utah, Salt Lake City, UT
| | - Ankita Date
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - Carlos Galvao
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - N Lynn Henry
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT
| |
Collapse
|
7
|
Wilson RL, Christopher CN, Yang EH, Barac A, Adams SC, Scott JM, Dieli-Conwright CM. Incorporating Exercise Training into Cardio-Oncology Care: Current Evidence and Opportunities: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2023; 5:553-569. [PMID: 37969654 PMCID: PMC10635898 DOI: 10.1016/j.jaccao.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/30/2023] [Indexed: 11/17/2023] Open
Abstract
Cancer treatment-induced cardiotoxicities are an ongoing concern throughout the cancer care continuum from treatment initiation to survivorship. Several "standard-of-care" primary, secondary, and tertiary prevention strategies are available to prevent the development or further progression of cancer treatment-induced cardiotoxicities and their risk factors. Despite exercise's established benefits on the cardiovascular system, it has not been widely adopted as a nonpharmacologic cardioprotective strategy within cardio-oncology care. In this state-of-the-art review, the authors discuss cancer treatment-induced cardiotoxicities, review the existing evidence supporting the role of exercise in preventing and managing these sequelae in at-risk and affected individuals living after cancer diagnoses, and propose considerations for implementing exercise-based services in cardio-oncology practice.
Collapse
Affiliation(s)
- Rebekah L. Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Cami N. Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Eric H. Yang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Ana Barac
- Inova Schar Heart and Vascular and Inova Schar Cancer Institute, Falls Church, Virginia, USA
| | - Scott C. Adams
- Department of Cardiology, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Jessica M. Scott
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Christina M. Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Abulfadl YS, El Ela YA, Al Khaiyat AM, Elkhodary KI, Badran M. Cyclophosphamide enfeebles myocardial isometric contraction force via RIP1/RIP3/MLKL/TRPM7-mediated necroptosis. Biomed Pharmacother 2023; 163:114819. [PMID: 37146416 DOI: 10.1016/j.biopha.2023.114819] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/23/2023] [Accepted: 04/30/2023] [Indexed: 05/07/2023] Open
Abstract
This study explores the negative impact of cyclophosphamide (CP) on cardiac contractility by specifically examining its effect on the active and passive tension of the cardiac muscle in-vitro and revealing the mechanism through which CP induces myocardial insult in-vivo. In young male Sprague-Dawley rats, cardiac toxicity was induced by a single intraperitoneal injection of CP (150 mg/kg body weight). Axial heart tissue slices were electrically stimulated, and the total isometric contraction force was measured at varying pretension levels. Blood and tissue biochemical assays, and histological/ immuno-histological assessments were conducted to evaluate the underlying molecular mechanisms. Statistical analysis shows that there is a significant difference between the drugged and the control groups in terms of the active tension values. Moreover, the pre-tension stress significantly affects both the active and passive tension values. CP altered heart, body, and heart-to-body weight, desolated cardiac muscle architecture, surged cardiac enzymes (CK-MB, LDH, and cTn l), augmented myocardial oxidative stressors (MDA), and weakened myocardial antioxidant status (SOD and GSH). Mechanistically, cyclophosphamide prompted the necroptotic trajectory evidenced by the activation of RIPK1, RIPK3, MLKL and TRPM7, the inhibition of caspase 8 and BCL2 and the upregulation of the protein/mRNA expression of TNF-α and TNFR1. This study identifies necroptosis as a key factor in cyclophosphamide-evoked myocardial contractility impairment, highlighting its potential as a target for alleviating antitumor-related myocardial damage. This innovative approach to investigating the underlying mechanisms of CP-induced cardiac toxicity offers valuable insights into the potential of developing new therapies to mitigate cyclophosphamide's negative impact.
Collapse
Affiliation(s)
- Yasmin S Abulfadl
- Department of Pharmacology, Toxicology, and Biochemistry, Faculty of Pharmacy, Future University in Egypt, New Cairo 11835, Egypt
| | - Yousef Abo El Ela
- Department of Mechanical Engineering, School of Sciences and Engineering, The American University in Cairo, New Cairo 11835, Egypt
| | - Abdallah M Al Khaiyat
- Department of Mechanical Engineering, School of Sciences and Engineering, The American University in Cairo, New Cairo 11835, Egypt
| | - Khalil I Elkhodary
- Department of Mechanical Engineering, School of Sciences and Engineering, The American University in Cairo, New Cairo 11835, Egypt
| | - Mohamed Badran
- Department of Mechanical Engineering, School of Sciences and Engineering, The American University in Cairo, New Cairo 11835, Egypt.
| |
Collapse
|
9
|
Jacobs JEJ, L'Hoyes W, Lauwens L, Yu Y, Brusselmans M, Weltens C, Voigt J, Wildiers H, Neven P, Herrmann J, Thijs L, Staessen JA, Janssens S, Van Aelst LNL. Mortality and Major Adverse Cardiac Events in Patients With Breast Cancer Receiving Radiotherapy: The First Decade. J Am Heart Assoc 2023; 12:e027855. [PMID: 37026536 PMCID: PMC10227262 DOI: 10.1161/jaha.122.027855] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/09/2023] [Indexed: 04/08/2023]
Abstract
Background Treatment for breast cancer (BC) frequently involves radiotherapy. Guidelines recommend screening for cardiac adverse events starting 10 years after radiotherapy. The rationale for this interval is unclear. Methods and Results We aimed to study cardiovascular event rates in the first decade following curative radiotherapy for BC. We compared mortality and cardiovascular event rates with an age- and risk factor-matched control population. We included 1095 patients with BC (mean age 56±12 years). Two hundred and eighteen (19.9%) women died. Cancer and cardiovascular mortality caused 107 (49.1%) and 22 (10.1%) deaths, respectively. A total of 904 cases were matched to female FLEMENGHO (Flemish Study on Environment, Genes and Health Outcomes) participants. Coronary artery disease incidence was similar (risk ratio [RR], 0.75 [95% CI, 0.48-1.18]), yet heart failure (RR, 1.97 [95% CI, 1.19-3.25]) and atrial fibrillation/flutter (RR, 1.82 [95% CI, 1.07-3.08]) occurred more often in patients with BC. Age (hazard ratio [HR], 1.033 [95% CI, 1.006-1.061], P=0.016), tumor grade (HR, 1.739 [95% CI, 1.166-2.591], P=0.007), and neoadjuvant treatment setting (HR, 2.782 [95% CI, 1.304-5.936], P=0.008) were risk factors for mortality. Risk factors for major adverse cardiac events were age (HR, 1.053 [95% CI, 1.013-1.093]; P=0.008), mean heart dose (HR, 1.093 [95% CI, 1.025-1.167]; P=0.007), history of cardiovascular disease (HR, 2.386 [95% CI, 1.096-6.197]; P=0.029) and Mayo Clinic Cardiotoxicity Risk Score (HR, 2.664 [95% CI, 1.625-4.367]; P<0.001). Conclusions Ten-year mortality following curative treatment for unilateral BC was mainly cancer related, but heart failure and atrial fibrillation/flutter were already common in the first decade following irradiation. Mean heart dose, pre-existing cardiovascular diseases, and Mayo Clinic Cardiotoxicity Risk Score were risk factors for cardiac adverse events. These results suggest a need for early dedicated cardio-oncological follow-up after radiotherapy.
Collapse
Affiliation(s)
- Johanna E. J. Jacobs
- Department of Cardiovascular DiseasesUniversity Hospitals (UZ) LeuvenLeuvenBelgium
| | - Wouter L'Hoyes
- Department of Cardiovascular DiseasesUniversity Hospitals (UZ) LeuvenLeuvenBelgium
| | - Lieselotte Lauwens
- Department of Radiation OncologyUniversity Hospitals (UZ) LeuvenLeuvenBelgium
| | - Yu‐Ling Yu
- Research Unit Environment and Health, KU Leuven Department of Public Health and Primary CareUniversity of LeuvenLeuvenBelgium
- Non‐Profit Research Association Alliance for the Promotion of Preventive Medicine (APPREMED)MechelenBelgium
| | - Marius Brusselmans
- Leuven Biostatistics and Statistical Bioinformatics Centre (L‐Biostat)LeuvenBelgium
| | - Caroline Weltens
- Department of Radiation OncologyUniversity Hospitals (UZ) LeuvenLeuvenBelgium
| | - Jens‐Uwe Voigt
- Department of Cardiovascular DiseasesUniversity Hospitals (UZ) LeuvenLeuvenBelgium
| | - Hans Wildiers
- Department of Medical OncologyUniversity Hospitals (UZ) LeuvenLeuvenBelgium
| | - Patrick Neven
- Department of GynaecologyUniversity Hospitals (UZ) LeuvenLeuvenBelgium
| | | | - Lutgarde Thijs
- Department of Cardiovascular DiseasesUniversity Hospitals (UZ) LeuvenLeuvenBelgium
| | - Jan A. Staessen
- Non‐Profit Research Association Alliance for the Promotion of Preventive Medicine (APPREMED)MechelenBelgium
- Biomedical Science Group, Faculty of MedicineUniversity of LeuvenLeuvenBelgium
| | - Stefan Janssens
- Department of Cardiovascular DiseasesUniversity Hospitals (UZ) LeuvenLeuvenBelgium
| | | |
Collapse
|
10
|
Cardiotoxicity of Selected Vascular Endothelial Growth Factor Receptor Tyrosine Kinase Inhibitors in Patients with Renal Cell Carcinoma. Biomedicines 2023; 11:biomedicines11010181. [PMID: 36672689 PMCID: PMC9855533 DOI: 10.3390/biomedicines11010181] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Renal cell carcinoma (RCC) is one of the most frequent malignant neoplasms of the kidney. The therapeutic options available for the treatment of advanced or metastatic RCC include vascular endothelial growth factor receptor (VEGFR)-targeted molecules, for example, tyrosine kinase inhibitors (TKI). Various VEGFR-TKIs proved to be effective in the treatment of patients with solid tumours. The combination of two drugs may prove most beneficial in the treatment of metastatic RCC; however, it also enhances the risk of toxicity compared to monotherapy. Specific VEGFR-TKIs (e.g., sunitinib, sorafenib or pazopanib) may increase the rate of cardiotoxicity in metastatic settings. VEGF inhibitors modulate multiple signalling pathways; thus, the identification of the mechanism underlying cardiotoxicity appears challenging. VEGF signalling is vital for the maintenance of cardiomyocyte homeostasis and cardiac function; therefore, its inhibition can be responsible for the reported adverse effects. Disturbed growth factor signalling pathways may be associated with endothelial dysfunction, impaired revascularization, the development of dilated cardiomyopathy, cardiac hypertrophies and altered peripheral vascular load. Patients at high cardiovascular risk at baseline could benefit from clinical follow-up in the first 2-4 weeks after the introduction of targeted molecular therapy; however, there is no consensus concerning the surveillance strategy.
Collapse
|
11
|
Liu X, Tao L, Wang M, Li H, Xu W. ABSDELL Model: Development and Internal Validation of a Risk Prediction Model of LVEF Decline in Breast Cancer Patients Treated With Trastuzumab. Clin Breast Cancer 2023; 23:23-31. [PMID: 36384817 DOI: 10.1016/j.clbc.2022.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION/BACKGROUND This study aims to establish an integrated model for predicting trastuzumab-associated decline of Left ventricular ejection fraction (LVEF) during drug administration. METHODS A retrospective study of 212 women who diagnosed with HER2-positive breast cancer and treated with chemotherapy and trastuzumab was conducted. Medical records were collected from 6 months before staring trastuzumab to 3 years afterwards. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to select variables, time-dependent receiver operating characteristic (ROC) curve and calibration plots were used to evaluate the model. The adjusted C-index and Brier scores were calculated using a bootstrap internal validation procedure. RESULTS The median age of participants is 53.2 years old. The median length of follow-up was 336 days. There were 72 patients (33.96%) whose LVEF declined ≥ 10% (10 absolute percent points). Seven factors, namely age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), mitral peak E-wave velocity (E-wave), left ventricular end-systolic diameter (LVESD) and LVEF, were selected. The name of the ABSDELL model was formed by the initials of each predictor. The area under the curve (AUC) of the model was 0.802 in 1 year and 0.881 in 3 years. Calibration plots indicate the predicted and actual probabilities were highly consistent. In the internal validation, 1-year and 3-year adjusted C-index was 0.801 and 0.881, and adjusted Brier score was 0.118 and 0.091, separately. CONCLUSION The ABSDELL model can effectively predicts the probability of LVEF decline in breast cancer patients treated with trastuzumab.
Collapse
Affiliation(s)
- Xin Liu
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Mopei Wang
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing, China
| | - Haiyan Li
- Department of Cardiology, Peking University Third Hospital, Beijing, China.
| | - Weixian Xu
- Department of Cardiology, Peking University Third Hospital, Beijing, China.
| |
Collapse
|
12
|
Turpin VRG, Lovoy GM, Parr SK, Hammond ST, Post HK, Caldwell JT, Banister HR, Scheuermann BC, Colburn TD, Ade CJ. Inorganic nitrate supplementation may improve diastolic function and the O 2 cost of exercise in cancer survivors: a pilot study. Support Care Cancer 2022; 31:63. [PMID: 36534177 DOI: 10.1007/s00520-022-07520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
In non-cancer populations, inorganic dietary nitrate (NO3-) supplementation is associated with enhanced cardiorespiratory function but remains untested in patients with a history of cancer. Therefore, this pilot study sought to determine if oral NO3- supplementation, as a supportive care strategy, increases left ventricular (LV) function and exercise performance in survivors of cancer treated with anticancer therapy while simultaneously evaluating the feasibility of the methods and procedures required for future large-scale randomized trials. Two cohorts of patients with a history of cancer treated with anticancer chemotherapy were recruited. Patients in cohort 1 (n = 7) completed a randomized, double-blind, crossover study with 7 days of NO3- or placebo (PL) supplementation, with echocardiography. Similarly, patients in cohort 2 (n = 6) received a single, acute dose of NO3- supplementation or PL. Pulmonary oxygen uptake (VO2), arterial blood pressure, and stroke volume were assessed during exercise. In cohort 1, NO3- improved LV strain rate in early filling (mean difference (MD) [95% CI]: - 0.3 1/s [- 0.6 to 0.06]; P = 0.04) and early mitral septal wall annular velocity (MD [95% CI]: 0.1 m/s [- 0.01 to - 0.001]; P = 0.02) compared to placebo. In cohort 2, NO3- decreased the O2 cost of low-intensity steady-state exercise (MD [95% CI]: - 0.5 ml/kg/min [- 0.9 to - 0.09]; P = 0.01). Resting and steady-state arterial blood pressure and stroke volume were not different between conditions. No differences between conditions for peak VO2 (MD [95% CI]: - 0.7 ml/kg/min [- 3.0 to 1.6]; P = 0.23) were observed. The findings from this pilot study warrant further investigation in larger clinical trials targeting the use of long-term inorganic dietary NO3- supplementation as a possible integrative supportive care strategy in patients following anticancer therapy.
Collapse
Affiliation(s)
- Vanessa-Rose G Turpin
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Garrett M Lovoy
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Shannon K Parr
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Stephen T Hammond
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Hunter K Post
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Jacob T Caldwell
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Heather R Banister
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Britton C Scheuermann
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Trenton D Colburn
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA
| | - Carl J Ade
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, USA. .,Physician Assistant Studies, College of Health and Human Sciences, Kansas State University, Manhattan, USA. .,Johnson Cancer Research Center, Kansas State University, Manhattan, USA. .,Clinical Integrative Physiology Laboratory, Kansas State University, Manhattan, KS, 66506, USA.
| |
Collapse
|
13
|
Lu Y, Gehr AW, Anikpo I, Meadows RJ, Craten KJ, Narra K, Lingam A, Kamath S, Tanna B, Ghabach B, Ojha RP. Cardiotoxicity among socioeconomically marginalized breast cancer patients. Breast Cancer Res Treat 2022; 195:401-411. [PMID: 35971056 PMCID: PMC9464741 DOI: 10.1007/s10549-022-06695-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE Evidence of cardiotoxicity risk related to anthracycline or trastuzumab exposure is largely derived from breast cancer cohorts that under-represent socioeconomically marginalized women, who may be at increased risk of cardiotoxicity because of high prevalence of cardiovascular disease risk factors. Therefore, we aimed to estimate cardiotoxicity risk among socioeconomically marginalized breast cancer patients treated with anthracyclines or trastuzumab and describe clinical consequences of cardiotoxicity. METHODS We linked electronic health records with institutional registry data from a Comprehensive Community Cancer Program within a safety-net health system. Eligible patients were adult females, diagnosed with first primary invasive breast cancer between 2013 and 2017, and initiated anthracyclines or trastuzumab as part of first-line therapy. We estimated cumulative incidence (risk) of cardiotoxicity with corresponding 95% confidence limits (CL) using the Aalen-Johansen estimator with death as competing risk. RESULTS Our study population comprised 169 women with breast cancer (103 initiated anthracyclines and 66 initiated trastuzumab). Cumulative incidence of cardiotoxicity was 21% (95% CL: 12%, 32%) at one year and 25% (95% CL: 15%, 35%) at three years among women who initiated trastuzumab, whereas cumulative incidence was 3.9% (95% CL: 1.3%, 8.9%) at one year and 5.9% (95% CL: 2.4%, 12%) at three years among women who initiated anthracyclines. More than half of patients with cardiotoxicity experienced interruption of cancer treatment. CONCLUSION Our findings suggest high risk of cardiotoxicity among socioeconomically marginalized breast cancer patients after initiation of anthracyclines or trastuzumab. Strategies are needed for optimizing cancer treatment effectiveness while minimizing cardiotoxicity in this population.
Collapse
Affiliation(s)
- Yan Lu
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Aaron W Gehr
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Ifedioranma Anikpo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rachel J Meadows
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Kevin J Craten
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Kalyani Narra
- Oncology and Infusion Center, JPS Health Network, Fort Worth, TX, USA
- Department of Internal Medicine, TCU School of Medicine, Fort Worth, TX, USA
| | - Anuradha Lingam
- Oncology and Infusion Center, JPS Health Network, Fort Worth, TX, USA
| | - Sandeep Kamath
- Department of Cardiology, JPS Health Network, Fort Worth, TX, USA
| | - Bhavna Tanna
- Department of Family Medicine, JPS Health Network, Fort Worth, TX, USA
| | - Bassam Ghabach
- Oncology and Infusion Center, JPS Health Network, Fort Worth, TX, USA
| | - Rohit P Ojha
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA.
| |
Collapse
|
14
|
Adhikari BB, Shi S, Dimond EP, Shelburne N, Desvigne-Nickens P, Minasian LM. Spectrum of National Institutes of Health-Funded Research in Cardio-Oncology: A Basic, Clinical, and Observational Science Perspective. Heart Fail Clin 2022; 18:515-528. [PMID: 35718423 PMCID: PMC9328446 DOI: 10.1016/j.hfc.2022.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Advances in cancer treatments have led to nearly 17 million survivors in the US today. Cardiovascular complications attributed to cancer treatments are the leading cause of morbidity and mortality in cancer survivors. In response, NCI and NHLBI held 2 workshops and issued funding opportunities to strengthen research on cardiotoxicity. A representative portfolio of NIH grants categorizing basic, interventional, and observational projects is presented. Compared with anthracyclines, research on radiation therapy and newer treatments is underrepresented. Multidisciplinary collaborative research that considers the cardiotoxicity stage and optimizes the balance between cardiovascular risk and cancer-treatment benefit might support continued improvements in cancer outcomes.
Collapse
Affiliation(s)
- Bishow B Adhikari
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH6705 Rockledge Drive, Room 313-J, MSC 7956, Bethesda, MD 20892-7956, USA.
| | - Scarlet Shi
- Division of Cardiovascular Sciences, NHLBI, NIH, 6705 Rockledge Drive, Room 313-H, MSC 7956, Bethesda, MD 20817, USA
| | - Eileen P Dimond
- Division of Cancer Prevention, NCI, NIH, 9609 Medical Center Drive Room 5E332, Bethesda, MD 20892, USA
| | - Nonniekaye Shelburne
- Division of Cancer Control and Population Sciences, NCI, NIH, 9609 Medical Center Drive Room 4E110, Bethesda, MD 20892, USA
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, NHLBI, NIH, 6705 One Rockledge Drive, Room 312-B2, Bethesda, MD 20892-7940, USA
| | - Lori M Minasian
- Division of Cancer Prevention, NCI, NIH, 9609 Medical Center Dr. Room 5E342, Bethesda, MD 20892, USA
| |
Collapse
|
15
|
Qiu S, Zhou T, Qiu B, Zhang Y, Zhou Y, Yu H, Zhang J, Liu L, Yuan L, Yang G, Duan Y, Xing C. Risk Factors for Anthracycline-Induced Cardiotoxicity. Front Cardiovasc Med 2021; 8:736854. [PMID: 34660739 PMCID: PMC8511483 DOI: 10.3389/fcvm.2021.736854] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Several cardiovascular risk factors have been suggested to be associated with anthracycline-induced cardiotoxicity, but their quantitative effects have not reached a consensus. Methods: We searched PubMed, EMBASE, and Cochrane Library databases for manuscripts published from inception to February 2021, which reported the results of cardiotoxicity due to anthracycline chemotherapy without trastuzumab. Cardiotoxicity defined by any reduction of left ventricular eject fraction (LVEF) to below 50% or a >10% reduction from baseline was defined as the primary endpoint. Odd ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model meta-analysis. Results: A total of 7,488 patients receiving anthracycline chemotherapy without trastuzumab were included, who had at least one risk factor at baseline. Hypertension (OR: 1.99; 95% CI: 1.43–2.76), diabetes mellitus (OR: 1.74; 95% CI: 1.11–2.74), and obesity (OR: 1.72; 95% CI: 1.13–2.61) were associated with increased risk of cardiotoxicity. In addition, the relative reduction of global longitudinal strain (GLS) from baseline after anthracycline treatment could significantly improve the detection ability of cardiotoxicity (28.5%, 95% CI: 22.1–35.8% vs. 16.4%, 95% CI: 13.4–19.9%) compared with LVEF. The early detection rate of anthracycline-induced cardiotoxicity (3 months after chemotherapy) by GLS was 30.2% (95% CI: 24.9–36.1%), which is similar with the overall result of GLS. Conclusions: Hypertension, diabetes mellitus, and obesity are associated with increased risk of anthracycline-induced cardiotoxicity, which indicates that corresponding protective strategies should be used during and after anthracycline treatment. The findings of higher detection rate and better early detection ability for cardiotoxicity than LVEF added new proofs for the advantages of GLS in detection of AIC.
Collapse
Affiliation(s)
- Shuo Qiu
- Department of Ultrasound Diagnostics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Tian Zhou
- Department of Ultrasound Diagnostics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Bo Qiu
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Yuxin Zhang
- Department of Ultrasound Diagnostics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Yonggang Zhou
- Department of Ultrasound Diagnostics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Huihui Yu
- School of Nursing, Air Force Medical University, Xi'an, China
| | - Jingyi Zhang
- Department of Hematology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Li Liu
- Department of Hematology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Lijun Yuan
- Department of Ultrasound Diagnostics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Guodong Yang
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
| | - Yunyou Duan
- Department of Ultrasound Diagnostics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Changyang Xing
- Department of Ultrasound Diagnostics, Tangdu Hospital, Air Force Medical University, Xi'an, China
| |
Collapse
|
16
|
Nonaka M, Hosoda H, Uezono Y. Cancer treatment-related cardiovascular disease: Current status and future research priorities. Biochem Pharmacol 2021; 190:114599. [PMID: 33989656 DOI: 10.1016/j.bcp.2021.114599] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
With the development of new drugs, such as molecular-targeted drugs, and multidisciplinary therapies, cancer treatment outcomes have improved, and the number of cancer survivors is increasing every year. However, some chemotherapeutic agents cause cardiovascular complications (cancer treatment-related cardiovascular disease, CTRCVD), which affect the life prognosis and quality of life (QOL) of cancer patients. Therefore, it is necessary to select treatment methods that take into account the prognosis and QOL of cancer patients, and to take measures against CTRCVD. The mechanism of cardiotoxicity of high-risk drugs, such as doxorubicin and HER2 inhibitors, are still unclear; genetic factors, and cardiovascular disease risk factors (e.g., hypertension, dyslipidemia, and diabetes) are associated with CTRCVD progression. The establishment of methods for prevention, early diagnosis, and treatment of CTRCVD and the generation of evidence for these methods are needed. It is also necessary to develop screening methods for chemotherapy cardiotoxicity. In this review, we discuss the current status of CTRCVD, its complications, and expected countermeasures.
Collapse
Affiliation(s)
- Miki Nonaka
- Department of Pain Control Research, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan(1)
| | - Hiroshi Hosoda
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita-City, Osaka 564-8565, Japan(1)
| | - Yasuhito Uezono
- Department of Pain Control Research, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan(1); Department of Pain Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Supportive and Palliative Care Research Support Office, National Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-City, Chiba 277-8577, Japan; Project for Supportive Care Research, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| |
Collapse
|
17
|
Ausoni S, Calamelli S, Saccà S, Azzarello G. How progressive cancer endangers the heart: an intriguing and underestimated problem. Cancer Metastasis Rev 2021; 39:535-552. [PMID: 32152913 DOI: 10.1007/s10555-020-09869-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since it came into being as a discipline, cardio-oncology has focused on the prevention and treatment of cardiotoxicity induced by antitumor chemotherapy and radiotherapy. Over time, it has been proved that even more detrimental is the direct effect generated by cancer cells that release pro-cachectic factors in the bloodstream. Secreted molecules target different organs at a distance, including the heart. Inflammatory and neuronal modulators released by the tumor bulk, either as free molecules or through exosomes, contribute to the pathogenesis of cardiac disease. Progressive cancer causes cachexia and severe cardiac muscle wasting accompanied by cardiomyocyte atrophy, tissue fibrosis, and several functional impairments up to heart failure. The molecular mechanisms responsible for such a cardiac muscle wasting have been partially elucidated in animal models, but minimally investigated in humans, although severe cardiac dysfunction exacerbates global cachexia and hampers efficient anti-cancer treatments. This review provides an overview of cancer-induced structural cardiac and functional damage, drawing on both clinical and scientific research. We start by looking at the pathophysiological mechanisms and evolving epidemiology and go on to discuss prevention, diagnosis, and a multimodal policy of intervention aimed at providing overall prognosis and global care for patients. Despite much interest in the cardiotoxicity of cancer therapies, the direct tumor effect on the heart remains poorly explored. There is still a lack of diagnostic criteria for the identification of the early stages of cardiac disease in cancer patients, while the possibilities that there are for effective prevention are largely underestimated. Research on innovative therapies has claimed considerable advances in preclinical studies, but none of the molecular targets suitable for clinical application has been approved for therapy. These issues are critically discussed here.
Collapse
Affiliation(s)
- Simonetta Ausoni
- Department of Biomedical Sciences, University of Padua, Padova, Italy.
| | - Sara Calamelli
- Department of Cardiology, Local Health Unit 3 Serenissima, Mirano Hospital, Mirano, Venice, Italy
| | - Salvatore Saccà
- Department of Cardiology, Local Health Unit 3 Serenissima, Mirano Hospital, Mirano, Venice, Italy
| | - Giuseppe Azzarello
- Department of Medical Oncology, Local Health Unit 3 Serenissima, Mirano Hospital, Mirano, Venice, Italy.
| |
Collapse
|
18
|
Weaver KE, Klepin HD, Wells BJ, Dressler EV, Winkfield KM, Lamar ZS, Avery TP, Pajewski NM, Hundley WG, Johnson A, Davidson EC, Lopetegui M, Foraker RE. Cardiovascular Assessment Tool for Breast Cancer Survivors and Oncology Providers: Usability Study. JMIR Cancer 2021; 7:e18396. [PMID: 33475511 PMCID: PMC7861995 DOI: 10.2196/18396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiovascular health is of increasing concern to breast cancer survivors and their health care providers, as many survivors are more likely to die from cardiovascular disease than cancer. Implementing clinical decision support tools to address cardiovascular risk factor awareness in the oncology setting may enhance survivors' attainment or maintenance of cardiovascular health. OBJECTIVE We sought to evaluate survivors' awareness of cardiovascular risk factors and examine the usability of a novel electronic health record enabled cardiovascular health tool from the perspective of both breast cancer survivors and oncology providers. METHODS Breast cancer survivors (n=49) recruited from a survivorship clinic interacted with the cardiovascular health tool and completed pre and posttool assessments about cardiovascular health knowledge and perceptions of the tool. Oncologists, physician assistants, and nurse practitioners (n=20) who provide care to survivors also viewed the cardiovascular health tool and completed assessments of perceived usability and acceptability. RESULTS Enrolled breast cancer survivors (84% White race, 4% Hispanic ethnicity) had been diagnosed 10.8 years ago (SD 6.0) with American Joint Committee on Cancer stage 0, I, or II (45/49, 92%). Prior to viewing the tool, 65% of survivors (32/49) reported not knowing their level for one or more cardiovascular health factors (range 0-4). On average, only 45% (range 0%-86%) of survivors' known cardiovascular health factors were at an ideal level. More than 50% of survivors had ideal smoking status (45/48, 94%) or blood glucose level (29/45, 64%); meanwhile, less than 50% had ideal blood pressure (12/49, 24%), body mass index (12/49, 24%), cholesterol level (17/35, 49%), diet (7/49, 14%), and physical activity (10/49. 20%). More than 90% of survivors thought the tool was easy to understand (46/47, 98%), improved their understanding (43/47, 91%), and was helpful (45/47, 96%); overall, 94% (44/47 survivors) liked the tool. A majority of survivors (44/47, 94%) thought oncologists should discuss cardiovascular health during survivorship care. Most (12/20, 60%) oncology providers (female: 12/20, 60%; physicians: 14/20, 70%) had been practicing for more than 5 years. Most providers agreed the tool provided useful information (18/20, 90%), would help their effectiveness (18/20, 90%), was easy to use (20/20, 100%), and presented information in a useful format (19/20, 95%); and 85% of providers (17/20) reported they would use the tool most or all of the time when providing survivorship care. CONCLUSIONS These usability data demonstrate acceptability of a cardiovascular health clinical decision support tool in oncology practices. Oncology providers and breast cancer survivors would likely value the integration of such apps in survivorship care. By increasing awareness and communication regarding cardiovascular health, electronic health record-enabled tools may improve survivorship care delivery for breast cancer and ultimately patient outcomes.
Collapse
Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Heidi D Klepin
- Section on Hematology-Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
- Department of Family Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Karen M Winkfield
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Zanetta S Lamar
- Section on Hematology-Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Tiffany P Avery
- Section on Hematology-Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - W Gregory Hundley
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Aimee Johnson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Eleanor C Davidson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Marcelo Lopetegui
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Randi E Foraker
- Institute for Informatics, Washington University in St Louis School of Medicine, St Louis, MO, United States
| |
Collapse
|
19
|
Dong S, Luo C, Hu X, Zhang J, Cai Q, Qian Y, Ran F, Ou W, Wang J, Huang Q, Ren T, Han G, Zhang F, Wei W, Liang X, Xu H, Wang S, Shi L, Wei S, Hu S. Expert Consensus for Treating Cancer Patients During the Pandemic of SARS-CoV-2. Front Oncol 2020; 10:1555. [PMID: 33014801 PMCID: PMC7462010 DOI: 10.3389/fonc.2020.01555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
The sudden pandemic of SARS-Cov-2 (also known as novel coronavirus disease 2019, COVID-19) poses a severe threat to hundreds of millions of lives in the world. The complete cure of the virus largely relies on the immune system, which becomes particularly a challenge for the cancer subjects, whose immunity is generally compromised. However, in a constant evolving situation, the clinical data on the prevalence of SARS-Cov-2 for cancer patients is still limited. On top of a wide range of medical references and interim guidelines including CDC, NCI, ASCO, ESMO, NCCN, AACR, ESMO, and the National Health Commission of China, etc., we formed into a guideline based on our experience in our specialized cancer hospital in Wuhan, the originally endemic center of the virus. Furthermore, we formulated an expert consensus which was developed by all contributors from different disciplines after fully discussion based on our understanding and analysis of limited information of COVID-19. The consensus highlighted a multidisciplinary team diagnostic model with assessment of the balance between risks and benefits prior to treatment, individualizing satisfaction of patients' medical needs, and acceptability in ethics and patients' socio-economic conditions.
Collapse
Affiliation(s)
- Shuang Dong
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Chenggang Luo
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
- Department of Radiological Intervention, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuebo Hu
- Laboratory of Drug Discovery and Molecular Engineering, Department of Medicinal Plants, College of Plant Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Jing Zhang
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Qian Cai
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Yu Qian
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Fengming Ran
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Wuling Ou
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
| | - Jun Wang
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Qing Huang
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Tianhua Ren
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Guang Han
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Zhang
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- Department of Hepatobiliary and Pancreatic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The Administration of Cancer Clinical Trials and GCP, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wei
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
- Radiotherapy Center, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinjun Liang
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Huiting Xu
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Sheng Wang
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- Department of Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lulu Shi
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
- The Administration of Cancer Clinical Trials and GCP, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaozhong Wei
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Hu
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
20
|
Clinical Practice and Research in Cardio-Oncology: Finding the "Rosetta Stone" for Establishing Program Excellence in Cardio-oncology. J Cardiovasc Transl Res 2020; 13:495-505. [PMID: 32444945 DOI: 10.1007/s12265-020-10010-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/17/2020] [Indexed: 02/06/2023]
Abstract
The burgeoning field of cardio-oncology (C-O) is now necessary for the delivery of excellent care for patients with cancer. Many factors have contributed to this increasing population of cancer survivors or those being treated with novel and targeted cancer therapies. There is a tremendous need to provide outstanding cardiovascular (CV) care for these patients; however, current medical literature actually provides a paucity of guidance. C-O therefore provides a novel opportunity for clinical, translational, and basic research to advance patient care. This review aims to be a primer for cardio-oncologists on how to develop a vibrant and comprehensive C-O program, use practical tools to assist in the construction of C-O services, and to proactively incorporate translational and clinical research into the training of future leaders as well as enhance clinical care.
Collapse
|
21
|
Shinano H, Miyazaki S, Miura K, Ohtsu H, Yonemoto N, Matsuoka K, Konishi H, Daida H, Saito M, Sase K. Risk Profiling of Cancer Treatment-Related Cardiovascular Disorders in Breast Cancer Patients Who Received Adjuvant Chemotherapy With Trastuzumab. Circ Rep 2020; 2:235-242. [PMID: 33693235 PMCID: PMC7921354 DOI: 10.1253/circrep.cr-19-0119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/31/2020] [Accepted: 02/18/2020] [Indexed: 01/03/2023] Open
Abstract
Background: The prognosis of cancer survivors has dramatically improved, but effective strategies for cancer treatment-related cardiovascular disorders (CTRCD) remain to be elucidated in the emerging field of cardio-oncology. In this study, we investigated risk factors for CTRCD in breast cancer patients treated with trastuzumab. Methods and Results: We performed a retrospective analysis of 141 consecutive women who received adjuvant trastuzumab, and underwent baseline (BL) and follow-up (FU) echocardiography at Juntendo University between April 2010 and December 2016. The major concomitant treatment was anthracyclines in 94% and radiotherapy in 53%. During the median treatment period of 11 months, there were 22 (15.6%) cardiology consultations, 3 (2.1%) treatment interruptions with irreversible CTRCD, and no deaths. Left ventricular ejection fraction (LVEF) was decreased from a median 67.5% (BL) to 63.4% (FU; P<0.0001), with reduced LVEF noted in 26.2% at FU<90%BL, in 13.5% at FU
Collapse
Affiliation(s)
- Hiromi Shinano
- Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University Tokyo Japan
| | - Sakiko Miyazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University Tokyo Japan
| | - Kayo Miura
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Juntendo University Tokyo Japan
| | - Hiroshi Ohtsu
- Leading Center for the Development and Research of Cancer Medicine, Juntendo University Tokyo Japan
- Center for Clinical Sciences, Department of Data Science, National Center for Global Health and Medicine Tokyo Japan
- Institute for Medical Regulatory Science, Organization for University Research Initiatives, Waseda University Tokyo Japan
| | - Naohiro Yonemoto
- Innovative Medical Technology Research & Development Center, Juntendo University Tokyo Japan
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry Tokyo Japan
| | - Kiyoshi Matsuoka
- Innovative Medical Technology Research & Development Center, Juntendo University Tokyo Japan
- Center for Clinical Sciences, Department of Data Science, National Center for Global Health and Medicine Tokyo Japan
| | - Hakuou Konishi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University Tokyo Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University Tokyo Japan
- Innovative Medical Technology Research & Development Center, Juntendo University Tokyo Japan
| | - Mitsue Saito
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Juntendo University Tokyo Japan
| | - Kazuhiro Sase
- Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University Tokyo Japan
- Institute for Medical Regulatory Science, Organization for University Research Initiatives, Waseda University Tokyo Japan
| |
Collapse
|
22
|
Hayek SS, Ganatra S, Lenneman C, Scherrer-Crosbie M, Leja M, Lenihan DJ, Yang E, Ryan TD, Liu J, Carver J, Mousavi N, O'Quinn R, Arnold A, Banchs J, Barac A, Ky B. Preparing the Cardiovascular Workforce to Care for Oncology Patients: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 73:2226-2235. [PMID: 31047011 DOI: 10.1016/j.jacc.2019.02.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/04/2019] [Indexed: 10/26/2022]
Abstract
Cardiovascular disease and cancer are the 2 main causes of death in the United States. They intersect on multiple levels, sharing common causal mechanisms and epidemiological risk factors. The growing prevalence and complexity of cardiovascular disease and cancer have resulted in the development of the discipline of cardio-oncology. Preparing the cardiovascular workforce for the care of a growing population of cancer patients is necessary to enhance the delivery of high-quality cardiovascular care for patients with cancer. The goal of this review is to present the dedicated efforts of the cardio-oncology community to meet the growing need for education and training of cardiovascular practitioners providing care to cancer patients and survivors. Integration in general cardiology training programs and the efforts of the stakeholder organizations serve as an example of how a multidimensional, innovative approach can address provider education and training needs in a relatively new discipline.
Collapse
Affiliation(s)
- Salim S Hayek
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Sarju Ganatra
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Carrie Lenneman
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Monika Leja
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Lenihan
- Division of Cardiology, Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri
| | - Eric Yang
- Division of Cardiology, University of California at Los Angeles, Los Angeles, California
| | - Thomas D Ryan
- Department of Pediatrics, University College of Medicine and Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Liu
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, New York
| | - Joseph Carver
- Division of Cardiology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Negareh Mousavi
- Division of Cardiology, McGill University, Montreal, Quebec, Canada
| | - Rupal O'Quinn
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anita Arnold
- Division of Cardiology, Florida State University, Tallahassee, Florida
| | - Jose Banchs
- Division of Cardiology, MD Anderson Cancer Center, Houston, Texas
| | - Ana Barac
- MedStar Heart and Vascular Institute, Washington, DC.
| | - Bonnie Ky
- Department of Epidemiology, Biostatistics and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
23
|
Casavecchia G, Galderisi M, Novo G, Gravina M, Santoro C, Agricola E, Capalbo S, Zicchino S, Cameli M, De Gennaro L, Righini FM, Monte I, Tocchetti CG, Brunetti ND, Cadeddu C, Mercuro G. Early diagnosis, clinical management, and follow-up of cardiovascular events with ponatinib. Heart Fail Rev 2020; 25:447-456. [DOI: 10.1007/s10741-020-09926-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
24
|
Zeng ZM, Xu P, Zhou S, Du HY, Jiang XL, Cai J, Huang L, Liu AW. Positive association between heart dosimetry parameters and a novel cardiac biomarker, solubleST-2, in thoracic cancer chest radiation. J Clin Lab Anal 2020; 34:e23150. [PMID: 31923333 PMCID: PMC7171349 DOI: 10.1002/jcla.23150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background Early screening and diagnosis of radiation‐induced heart disease (RIHD) is difficult in patients with chest radiation exposure. sST‐2 is involved in myocardial stress or injury. We evaluated the relationship between heart dose parameters and sST‐2 changes in chest malignant tumor patients who received chest radiation. Methods We prospectively collected thoracic malignancy cancer patients who had received chest radiotherapy. Heart dosimetry parameters were extracted from the treatment planning system. sST‐2 was measured at baseline, the middle stage, and after radiotherapy (recorded as pre‐ST‐2, mid‐ST‐2, and post‐ST‐2). sST‐2 change rate was calculated. Scatter plots showed the relationship between cardiac dose parameters and ST‐2 change rate. Multiple regression was used to analyze the relationship between cardiac dose parameters and ST‐2 change rate. Results Totally, 60 patients were enrolled. The mean V5, V10, V20, V30, V40, and MHD was 60.93 ± 27.79%, 51.43 ± 25.44%, 39.17 ± 21.75%, 28.07 ± 17.15%,18.66 ± 12.18%, and 18.60 ± 8.63 Gy, respectively. The median M‐LAD was 11.31 (IQR 3.33‐18.76) Gy. The mean pre‐ST‐2, mid‐ST‐2, and post‐ST‐2 was 5.1 ± 3.8, 6.4 ± 3.9, and 7.6 ± 4.4, respectively. sST‐2 was elevated with thoracic irradiation (P < .001). Multivariate linear regression analyses showed that V5, V10, V20, and MHD were independently and positively associated with ST‐2 change rate (β = .04, .04, .04, and .10, respectively, all P < .05). Conclusion Serum sST‐2 levels were elevated over time during radiotherapy. V5, V10, V20 and MHD were independently and positively associated with the elevated ST‐2 change rate.
Collapse
Affiliation(s)
- Zhi-Min Zeng
- Department of Oncology, The second affiliated hospital of Nanchang University, Nanchang, China.,Jiangxi key laboratory of clinical translational cancer research, The second affiliated hospital of Nanchang University, Nanchang, China
| | - Peng Xu
- Department of Oncology, The second affiliated hospital of Nanchang University, Nanchang, China.,Jiangxi key laboratory of clinical translational cancer research, The second affiliated hospital of Nanchang University, Nanchang, China
| | - Shan Zhou
- Department of Oncology, The second affiliated hospital of Nanchang University, Nanchang, China
| | - Hai-Yang Du
- Department of Oncology, The second affiliated hospital of Nanchang University, Nanchang, China
| | - Xiao-Liu Jiang
- Department of Oncology, The second affiliated hospital of Nanchang University, Nanchang, China
| | - Jing Cai
- Department of Oncology, The second affiliated hospital of Nanchang University, Nanchang, China
| | - Long Huang
- Department of Oncology, The second affiliated hospital of Nanchang University, Nanchang, China.,Jiangxi key laboratory of clinical translational cancer research, The second affiliated hospital of Nanchang University, Nanchang, China
| | - An-Wen Liu
- Department of Oncology, The second affiliated hospital of Nanchang University, Nanchang, China.,Jiangxi key laboratory of clinical translational cancer research, The second affiliated hospital of Nanchang University, Nanchang, China
| |
Collapse
|
25
|
Padegimas A, Clasen S, Ky B. Cardioprotective strategies to prevent breast cancer therapy-induced cardiotoxicity. Trends Cardiovasc Med 2020; 30:22-28. [PMID: 30745071 PMCID: PMC7287268 DOI: 10.1016/j.tcm.2019.01.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/08/2019] [Accepted: 01/21/2019] [Indexed: 12/14/2022]
Abstract
Breast cancer is the most common malignancy affecting females, with over 260,000 new cases annually and over 3.1 million survivors in the United States alone. Exposure to potentially cardiotoxic therapies, including anthracyclines, trastuzumab, and radiation therapy, coupled with host factors, place patients at increased risk for the development of cardiovascular disease (CVD) compared to non-cancer controls. Overall survival outcomes are significantly worse in patients who develop CVD, and in certain breast cancer populations, cardiovascular death exceeds the risk of cancer death in the long-term. In order to mitigate the risk of CVD, there is a growing interest in the use of cardioprotective strategies at the time of cancer therapy initiation. In this review, we present a detailed evaluation of the evidence from recently completed as well as ongoing cardio-oncology clinical trials in pharmacologic cardioprotection in breast cancer patients. We focus primarily on the potential role of dexrazoxane, alterations in anthracycline dosing or formulation, neurohormonal antagonists, beta-blockers, and combination therapy. We also discuss ongoing studies in statin cardioprotection, radiation delivery strategies, use of risk-guided strategies and the study of specific cancer populations. We close with a discussion of the ongoing needs in the field of cardio-oncology in order to advance the clinical care of patients with rigorous, evidence-based medicine.
Collapse
Affiliation(s)
- Allison Padegimas
- Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Suparna Clasen
- Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Bonnie Ky
- Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
| |
Collapse
|
26
|
Pfeffer TJ, Schlothauer S, Pietzsch S, Schaufelberger M, Auber B, Ricke-Hoch M, List M, Berliner D, Abou Moulig V, König T, Arany Z, Sliwa K, Bauersachs J, Hilfiker-Kleiner D. Increased Cancer Prevalence in Peripartum Cardiomyopathy. JACC: CARDIOONCOLOGY 2019; 1:196-205. [PMID: 34396183 PMCID: PMC8352111 DOI: 10.1016/j.jaccao.2019.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/23/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022]
Abstract
Objectives This study was designed to analyze the prevalence and potential genetic basis of cancer and heart failure in peripartum cardiomyopathy (PPCM). Background PPCM manifests as heart failure late in pregnancy or postpartum in women without previous heart disease. Methods Clinical history and cancer prevalence were evaluated in a cohort of 236 PPCM patients from Germany and Sweden. Exome sequencing assessed variants in 133 genes associated with cancer predisposition syndromes (CPS) and in 115 genes associated with dilated/hypertrophic cardiomyopathy (DCM/HCM) in 14 PPCM patients with a history of cancer, and in 6 PPCM patients without a history of cancer. Results The prevalence of cancer was 16-fold higher (8.9%, 21 of 236 patients) in PPCM patients compared to age-matched women (German cancer registry, Robert-Koch-Institute: 0.59%; p < 0.001). Cancer before PPCM occurred in 12 of 21 patients of whom 11 obtained cardiotoxic cancer therapies. Of those, 17% fully recovered cardiac function by 7 ± 2 months of follow-up compared to 55% of PPCM patients without cancer (p = 0.015). Cancer occurred after PPCM in 10 of 21 patients; 80% had left ventricular ejection fraction of ≥50% after cancer therapy. Whole-exome sequencing in 14 PPCM patients with cancer revealed that 43% (6 of 14 patients) carried likely pathogenic (Class IV) or pathogenic (Class V) gene variants associated with DCM/HCM in CPT2, DSP, MYH7, TTN, and/or with CPS in ATM, ERCC5, NBN, RECQL4, and SLX4. All CPS variants affected DNA damage response genes. Conclusions Cardiotoxic cancer therapy before PPCM is associated with delayed full recovery. The high cancer prevalence in PPCM is linked to likely pathogenic/pathogenic gene variants associated with DCM/HCM and/or CPS/DNA damage response-related cancer risk. This may warrant genetic testing and screening for heart failure in pregnant women with a cancer history and screening for cancer in PPCM patients.
Collapse
Key Words
- ATM, ataxia telangiectasia mutated
- BMBF, Bundesministerium für Bildung und Forschung
- BRCA1, breast cancer 1
- CPS, cancer predisposition syndrome
- DCM, dilated cardiomyopathy
- DDR, DNA damage response
- DFG, Deutsche Forschungsgesellschaft
- ERCC5, excision repair cross-complementing rodent repair deficiency
- FANCA, Fanconi anemia, complementation group
- FKRP, fukutin-related protein
- HCM, hypertrophic cardiomyopathy
- HTX, heart transplantation
- LVAD, left ventricular assist device
- LVEF, left ventricular ejection fraction
- PPCM, peripartum cardiomyopathy
- RECQL4, ATP-dependent DNA helicase Q4
- RYR1, ryanodine receptor 1
- SLX4, structure-specific endonuclease subunit SLX4
- TXNRD2, thioredoxin reductase 2
- VUS, variants of unknown significance
- cancer
- cardiotoxicity
- genetics
- peripartum cardiomyopathy
- whole-exome sequencing
Collapse
Affiliation(s)
- Tobias J Pfeffer
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Stella Schlothauer
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Stefan Pietzsch
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bernd Auber
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Melanie Ricke-Hoch
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Manuel List
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Valeska Abou Moulig
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Tobias König
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Zolt Arany
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
27
|
Abstract
As cancer therapies improve, the population of survivors of cancer has increased, and the long-term effects of cancer treatments have become more apparent. Cardiotoxicity is a well-established adverse effect of many antineoplastic agents. Hypertension is common in survivors of cancer, can be caused or worsened by certain agents, and has been shown to increase the risk of other cardiovascular diseases including heart failure. Pretreatment risk assessment and careful monitoring of blood pressure during therapy is essential. Aggressive management of preexisting or incident hypertension in survivors of cancer is paramount to decrease the risk of heart failure and other cardiovascular diseases in these patients.
Collapse
Affiliation(s)
- Lauren J Hassen
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, 3rd Floor, Columbus, OH 43210-1267, USA.
| | - Daniel J Lenihan
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Cardio-Oncology Center of Excellence, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Campus Box 8086, St Louis, MO 63110, USA
| | - Ragavendra R Baliga
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Cardio-Oncology Center of Excellence, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, 200 DHLRI, Columbus, OH 43210-1267, USA
| |
Collapse
|
28
|
Improving paediatric cardiologists' awareness about the needs of childhood cancer survivors: results of a single-centre directed educational initiative. Cardiol Young 2019; 29:808-812. [PMID: 31280730 DOI: 10.1017/s104795111900088x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cardiovascular disease is a leading cause of morbidity and mortality in childhood cancer survivors. Cardiologists must be aware of risk factors and long-term follow-up guidelines, which have historically been the purview of oncologists. Little is known about paediatric cardiologists' knowledge regarding the cardiotoxicity of cancer treatment and how to improve this knowledge. METHODS A total of 58 paediatric cardiologists anonymously completed a 21-question, web-based survey focused on four cardio-oncology themes: cancer treatment-related risk factors (n = 6), patient-related risk factors (n = 6), recommended surveillance (n = 3), and cardiac-specific considerations (n = 6). Following the baseline survey, a multi-disciplinary team of paediatric cardiologists and cancer survivor providers developed an in-person and web-based educational intervention. A post-intervention survey was conducted 5 months later. RESULTS The response rate was 41/58 (70.7%) pre-intervention and 30/58 (51.7%) post-intervention. On the baseline survey, the percentage of correct answers was 68.8 ± 10.3%, which improved to 79.2 ± 16.2% after the intervention (p = 0.009). The theme with the most profound knowledge deficit was surveillance; however, it also had the greatest improvement after the intervention (49.6 ± 26.7 versus 66.7 ± 27.7% correct, p = 0.025). Individual questions with the largest per cent improvement pertained to risk of cardiac dysfunction with time since treatment (52.4 versus 93.1%, p = 0.002) and the role of dexrazoxane (48.8 versus 82.8%, p = 0.020). CONCLUSION Specific knowledge deficits about the care of paediatric cancer survivors were identified amongst cardiologists using a web-based survey. Knowledge of surveillance was initially lowest but improved the most after an educational intervention. This highlights the need for cardio-oncology-based educational initiatives among paediatric cardiologists.
Collapse
|
29
|
Abstract
PURPOSE OF REVIEW With the rapid development of novel cancer therapeutics and the growing number of cancer survivors, there is significant demand for cardio-oncology experts to care for these patients. As such, it has become increasingly necessary to develop formalized training in the field of cardio-oncology. This review will focus on the current state of cardio-oncology education, with recommendations for the development of dedicated cardio-oncology fellowships. RECENT FINDINGS Cardio-oncology fellowships should be affiliated with high-volume centers that have established cardio-oncology clinical and research programs with dedicated cardio-oncology faculty. Several recent publications have proposed recommendations to develop uniform cardio-oncology training standards, core curricula, and evaluation metrics. With the rapid evolution of the field and the support of various profession organizations, the number and quality of dedicated cardio-oncology fellowship programs is expected to increase significantly. The adoption of defined training requirements and evaluation standards to measure competency will be essential to ensure the legitimacy and success of the field.
Collapse
Affiliation(s)
- Michael G Fradley
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, 12902 USF Magnolia Dr., MCB-CPT, Tampa, FL, 33612-9416, USA.
| |
Collapse
|
30
|
López-Candales A. Cardio-oncology: in search of the right balance. Postgrad Med 2019; 131:79-81. [DOI: 10.1080/00325481.2019.1568020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Angel López-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| |
Collapse
|
31
|
Changing Hearts and Minds: Improving Outcomes in Cancer Treatment-Related Cardiotoxicity. Curr Oncol Rep 2019; 21:9. [DOI: 10.1007/s11912-019-0751-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
32
|
Cancer and the Broken Heart: Complications and Implications of Therapy-Related Cardiotoxicity. JOURNAL OF INFUSION NURSING 2018; 41:229-240. [PMID: 29958259 DOI: 10.1097/nan.0000000000000285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The growing number of adult long-term cancer survivors has expanded our knowledge of negative physiologic sequelae associated with curative therapies. Of note are the cardiovascular corollaries of chest radiotherapy and some commonly used chemotherapy agents. A contemporary understanding of risk factors has facilitated the development of guidelines for prevention and surveillance of cardiac compromise. The future holds promise with enhanced opportunities to use cardioprotectant drugs and biomarkers to prevent and detect early myocardial changes. Infusion therapy nurses must keep abreast of these developments to facilitate their roles as patient educators and advocates in the face of this toxicity's prevalence.
Collapse
|
33
|
Affiliation(s)
- Sergey Ryzhov
- From the Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough (S.R., D.B.S.); and the Department of Cardiac Services, Maine Medical Center, Portland (S.F., D.B.S.)
| | - Sanjeev Francis
- From the Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough (S.R., D.B.S.); and the Department of Cardiac Services, Maine Medical Center, Portland (S.F., D.B.S.)
| | - Douglas B Sawyer
- From the Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough (S.R., D.B.S.); and the Department of Cardiac Services, Maine Medical Center, Portland (S.F., D.B.S.).
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW As the number of cancer survivors continues to rise with improved early-detection methods and advancing therapies, along with it, there come adverse health outcomes as a result of physiological and psychological effects of cancer, as well as adverse effects of cancer treatment itself. This paper reviews the risk of cardiovascular disease in cancer survivors. RECENT FINDINGS Cancer survivors are at higher risk of having modifiable cardiovascular (CV) risk factors, such as hypertension, diabetes mellitus, obesity, tobacco smoking, and physical inactivity. Cardiotoxicity is a well-established adverse effect of various anticancer regimens, which further elevates the cardiovascular risk in cancer patients. The increased risk of CVD and CVD-related death in cancer survivors is likely to be multifactorial, involving cardiotoxic effects of cancer treatments as well as comorbidities and harmful lifestyle habits. Targeting and managing known cardiac risk factors should be a main target in CVD prevention in cancer survivors.
Collapse
Affiliation(s)
- Inbar Agmon Nardi
- Department of Internal Medicine F (Recanati), Rabin Medical Center-Beilinson, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zaza Iakobishvili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Cardiology, Holon Medical Center, Clalit Health Services, Tel Aviv, Israel.
| |
Collapse
|
35
|
Singh J, Valero-Elizondo J, Salami JA, Warraich HJ, Ogunmoroti O, Spatz ES, Desai N, Rana JS, Virani SS, Blankstein R, Blaha MJ, Nasir K. Favorable Modifiable Cardiovascular Risk Profile Is Associated With Lower Healthcare Costs Among Cancer Patients: The 2012-2013 Medical Expenditure Panel Survey. J Am Heart Assoc 2018; 7:e007874. [PMID: 29686026 PMCID: PMC6015292 DOI: 10.1161/jaha.117.007874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/11/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) and cancer are among the leading causes of economic burden, morbidity, and mortality in the United States. We aimed to quantify the overall impact of cardiovascular modifiable risk factor (CRF) profile on healthcare expenditures among those with and without ASCVD and/or cancer. METHODS AND RESULTS The 2012-2013 Medical Expenditure Panel Survey, a nationally representative adult sample (≥40 years), was utilized for the study. Variables included ASCVD, CRF (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity and/or obesity), and cancer (all). Two-part econometric models analyzed cost data. Medical Expenditure Panel Survey participants (n=27 275, 59±9 years, 52% female) were studied and 14% had cancer, translating to 25.6 million US adults over 40 years of age. A higher prevalence of ASCVD was noted in those with versus without cancer (25% versus 14%). Absence of ASCVD and a more favorable CRF profile were associated with significantly lower expenditures across the spectrum of cancer diagnosis. Among cancer patients, the adjusted mean annual cost for those with and without ASCVD were $10 852 (95% confidence interval [8917, 12 788]) and $6436 (95% confidence interval [5531, 7342]). Among cancer patients without ASCVD, adjusted annual healthcare expenditures among those with optimal versus poor CRF profile were $4782 and $7256. CONCLUSIONS In a nationally representative US adult population, absence of ASCVD and a favorable CRF profile were associated with significantly lower medical expenditure among cancer patients. This provides estimates to continue better cardiovascular management and prevention practices, while contextualizing the burden of cancer.
Collapse
Affiliation(s)
- Jai Singh
- Vanderbilt University Medical Center, Nashville, TN
| | - Javier Valero-Elizondo
- Tecnologico de Monterrey, Catedra de Cardiologia y Medicina Vascular, Nuevo Leon, Mexico
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL
| | - Joseph A Salami
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL
| | - Haider J Warraich
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, NC
| | - Oluseye Ogunmoroti
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Section of Cardiovascular Medicine, Yale University, New Haven, CT
| | - Nihar Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Section of Cardiovascular Medicine, Yale University, New Haven, CT
| | - Jamal S Rana
- Division of Cardiology and Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Salim S Virani
- Michael E. DeBakey VA Medical Center & Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX
| | - Ron Blankstein
- Non-Invasive Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD
| | - Khurram Nasir
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Section of Cardiovascular Medicine, Yale University, New Haven, CT
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD
- Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL
| |
Collapse
|
36
|
Abstract
Breast cancer is the most common malignancy in women with more than 3 million breast cancer survivors in the United States alone. Survivors of breast cancer suffer from an increased burden of cardiovascular risk factors and disease. The focus of this review is to describe the epidemiology of cardiovascular disease in breast cancer survivors, including the cardiovascular concerns observed with common cancer therapies. Strategies to improve upon the early detection and treatment of cardiovascular disease, including clinical prediction algorithms, biomarkers, and imaging measures are also reviewed, and the use of cardioprotective therapies to mitigate risk are summarized. Finally, the need for evidence-based research to inform and improve upon the multidisciplinary care of this growing population is highlighted.
Collapse
Affiliation(s)
- Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
37
|
Harrison J, Friese C, Barton D, Janz N, Pressler S, Davis M. Heart Failure and Long-Term Survival Among Older Women With Breast Cancer. Oncol Nurs Forum 2018. [DOI: 10.1188/18.onf.77-87] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
38
|
Yarana C, Carroll D, Chen J, Chaiswing L, Zhao Y, Noel T, Alstott M, Bae Y, Dressler EV, Moscow JA, Butterfield DA, Zhu H, St Clair DK. Extracellular Vesicles Released by Cardiomyocytes in a Doxorubicin-Induced Cardiac Injury Mouse Model Contain Protein Biomarkers of Early Cardiac Injury. Clin Cancer Res 2017; 24:1644-1653. [PMID: 29070527 DOI: 10.1158/1078-0432.ccr-17-2046] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/08/2017] [Accepted: 10/18/2017] [Indexed: 01/21/2023]
Abstract
Purpose: Cardiac injury is a major cause of death in cancer survivors, and biomarkers for it are detectable only after tissue injury has occurred. Extracellular vesicles (EV) remove toxic biomolecules from tissues and can be detected in the blood. Here, we evaluate the potential of using circulating EVs as early diagnostic markers for long-term cardiac injury.Experimental Design: Using a mouse model of doxorubicin (DOX)-induced cardiac injury, we quantified serum EVs, analyzed proteomes, measured oxidized protein levels in serum EVs released after DOX treatment, and investigated the alteration of EV content.Results: Treatment with DOX caused a significant increase in circulating EVs (DOX_EV) compared with saline-treated controls. DOX_EVs exhibited a higher level of 4-hydroxynonenal adducted proteins, a lipid peroxidation product linked to DOX-induced cardiotoxicity. Proteomic profiling of DOX_EVs revealed the distinctive presence of brain/heart, muscle, and liver isoforms of glycogen phosphorylase (GP), and their origins were verified to be heart, skeletal muscle, and liver, respectively. The presence of brain/heart GP (PYGB) in DOX_EVs correlated with a reduction of PYGB in heart, but not brain tissues. Manganese superoxide dismutase (MnSOD) overexpression, as well as pretreatment with cardioprotective agents and MnSOD mimetics, resulted in a reduction of EV-associated PYGB in mice treated with DOX. Kinetic studies indicated that EVs containing PYGB were released prior to the rise of cardiac troponin in the blood after DOX treatment, suggesting that PYGB is an early indicator of cardiac injury.Conclusions: EVs containing PYGB are an early and sensitive biomarker of cardiac injury. Clin Cancer Res; 24(7); 1644-53. ©2017 AACRSee related commentary by Zhu and Gius, p. 1516.
Collapse
Affiliation(s)
- Chontida Yarana
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky.,Faculty of Medical Technology, Mahidol University, Salaya, Thailand
| | - Dustin Carroll
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky
| | - Jing Chen
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, Kentucky
| | - Luksana Chaiswing
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky
| | - Yanming Zhao
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky
| | - Teresa Noel
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky
| | - Michael Alstott
- Markey Cancer Center, Redox Metabolism Shared Resource Facility, University of Kentucky, Lexington, Kentucky
| | - Younsoo Bae
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, Kentucky
| | - Emily V Dressler
- Division of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jeffrey A Moscow
- Investigational Drug Branch, National Cancer Institute, Bethesda, Maryland
| | - D Allan Butterfield
- Markey Cancer Center, Redox Metabolism Shared Resource Facility, University of Kentucky, Lexington, Kentucky.,Department of Chemistry, University of Kentucky, Lexington, Kentucky
| | - Haining Zhu
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky.,Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, Kentucky.,Markey Cancer Center, Redox Metabolism Shared Resource Facility, University of Kentucky, Lexington, Kentucky
| | - Daret K St Clair
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, Kentucky.
| |
Collapse
|
39
|
Noonan K, Rome S, Faiman B, Verina D. Heart and Lung Complications: Assessment and Prevention of Venous Thromboembolism and Cardiovascular Disease in Patients With Multiple Myeloma
. Clin J Oncol Nurs 2017; 21:37-46. [PMID: 28945734 DOI: 10.1188/17.cjon.s5.37-46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) and cardiovascular (CV) disease can occur in patients with multiple myeloma. Although VTE and CV disease are separate medical conditions, they can be serious and even life-threatening.
. OBJECTIVES The objectives of this article are to describe risk factors for cancer-associated VTE, describe the influence of CV disease on patients with multiple myeloma, and review the approaches to VTE and CV disease identification and treatment.
. METHODS PubMed and CINAHL® databases were used to identify literature to describe VTE and CV in patients diagnosed with multiple myeloma.
. FINDINGS When present in patients with multiple myeloma, VTE and CV disease can limit patient tolerance for myeloma treatment and, therefore, decrease therapeutic options.
Collapse
|
40
|
Winning the battle, but losing the war: mechanisms and morphology of cancer-therapy-associated cardiovascular toxicity. Cardiovasc Pathol 2017; 30:55-63. [DOI: 10.1016/j.carpath.2017.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 01/08/2023] Open
|
41
|
Bansal N, Amdani S, Lipshultz ER, Lipshultz SE. Chemotherapy-induced cardiotoxicity in children. Expert Opin Drug Metab Toxicol 2017; 13:817-832. [DOI: 10.1080/17425255.2017.1351547] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Neha Bansal
- Department of Pediatrics, Wayne State University School of Medicine and Children’s Hospital of Michigan, Detroit, MI, USA
| | - Shahnawaz Amdani
- Department of Pediatrics, Wayne State University School of Medicine and Children’s Hospital of Michigan, Detroit, MI, USA
| | - Emma R. Lipshultz
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steven E. Lipshultz
- Department of Pediatrics, Wayne State University School of Medicine and Children’s Hospital of Michigan, Detroit, MI, USA
- Karmanos Cancer Institute, Detroit, MI, USA
| |
Collapse
|
42
|
Henning RJ, Harbison RD. Cardio-oncology: cardiovascular complications of cancer therapy. Future Cardiol 2017; 13:379-396. [DOI: 10.2217/fca-2016-0081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This paper focuses on three classes of commonly used anticancer drugs, which can cause cardiotoxicity: anthracyclines, monoclonal antibodies exemplified by trastuzumab and tyrosine kinase inhibitors. Anthracyclines can induce cardiomyocyte necrosis and fibrosis. Trastuzumab can cause cardiac stunning. The tyrosine kinase inhibitors can increase systemic arterial pressure and impair myocyte contractility. In addition, radiation therapy to the mediastinum or left chest can exacerbate the cardiotoxicity of these anticancer drugs and can also cause accelerated atherosclerosis, myocardial infarction, heart failure and arrhythmias. Left ventricular ejection fraction measurements are most commonly used to assess cardiac function in patients who receive chemo- or radiation-therapy. However, echocardiographic determinations of global longitudinal strain are more sensitive for detection of early left ventricular systolic dysfunction. Information on patient-risk stratification and monitoring is presented and guidelines for the medical treatment of cardiac dysfunction due to cancer therapies are summarized.
Collapse
Affiliation(s)
- Robert J Henning
- Department of Environmental & Occupational Health, College of Public Health, University of South Florida, and the James A Haley Hospital, Tampa, FL 33612-3805, USA
| | - Raymond D Harbison
- Department of Environmental & Occupational Health, College of Public Health, University of South Florida, and the James A Haley Hospital, Tampa, FL 33612-3805, USA
| |
Collapse
|
43
|
Ghosh AK, Walker JM. Cardio-Oncology - A new subspecialty with collaboration at its heart. Indian Heart J 2017; 69:556-562. [PMID: 28822531 PMCID: PMC5560887 DOI: 10.1016/j.ihj.2017.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 05/05/2017] [Indexed: 12/20/2022] Open
Abstract
Cardio-Oncology is the care of cancer patients with cardiovascular disease, overt or occult, already established or acquired during treatment. Cancer patients can present with a variety of cardiovascular problems not all of which are directly related to cancer therapy (medications or radiotherapy). The cardiovascular problems of oncology patients can range from ischaemia to arrhythmias and can also include valve problems and heart failure. As such, within cardiology, teamwork is required with members of different cardiology subspecialties. The way forward will be to adopt a multidisciplinary approach to produce optimal individual care. Close collaboration between cardiology and oncology specialists in a Cardio-Oncology setting can make this happen.
Collapse
Affiliation(s)
- Arjun K Ghosh
- Barts Heart Centre, St Bartholomew's Hospital and Hatter Cardiovascular Institute, University College London Hospital, United Kingdom.
| | - J Malcolm Walker
- Hatter Cardiovascular Institute, University College London Hospital, United Kingdom
| |
Collapse
|
44
|
Reyes-Gibby CC, Melkonian SC, Hanna EY, Yeung SCJ, Lu C, Chambers MS, Banala SR, Gunn GB, Shete SS. Cohort study of oncologic emergencies in patients with head and neck cancer. Head Neck 2017; 39:1195-1204. [PMID: 28346771 PMCID: PMC5429871 DOI: 10.1002/hed.24748] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Treatments for head and neck squamous cell carcinoma (HNSCC) are associated with toxicities that lead to emergency department presentation. METHODS We utilized data from an ongoing prospective cohort of newly diagnosed, previously untreated patients (N = 298) with HNSCC to evaluate the association between clinical and epidemiologic factors and risk for and frequency of emergency department presentation. Time to event was calculated from the date of treatment initiation to emergency department presentation, date of death, or current date. Frequency of emergency department presentation was the sum of emergency department visits during the follow-up time. RESULTS History of hypertension, normal/underweight body mass index (BMI), and probable depression predicted increased risk for emergency department presentation. BMI and severe pain were associated with higher frequency of emergency department presentations. CONCLUSION Clinical and epidemiologic factors can help predict patients with HNSCC who will present to the emergency department. Such knowledge may improve treatment-related patient outcomes and quality of life. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1195-1204, 2017.
Collapse
Affiliation(s)
- Cielito C. Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephanie C. Melkonian
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sai-ching J. Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles Lu
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark S. Chambers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Srinivas R. Banala
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary B. Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanjay S. Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
45
|
|
46
|
Galician consensus on management of cardiotoxicity in breast cancer: risk factors, prevention, and early intervention. Clin Transl Oncol 2017; 19:1067-1078. [PMID: 28342058 PMCID: PMC5547178 DOI: 10.1007/s12094-017-1648-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/13/2017] [Indexed: 12/22/2022]
Abstract
This Galician consensus statement is a joint oncologists/cardiologists initiative indented to establish basic recommendations on how to prevent and to manage the cardiotoxicity in breast cancer with the aim of ensuring an optimal cardiovascular care of these patients. A clinical screening of the patients before treatment is recommended to stratify them into a determined risk group based on their intrinsic cardiovascular risk factors and those extrinsic arose from breast cancer therapy, thereby providing individualized preventive and monitoring measures. Suitable initial and ongoing assessments for patients with low and moderate/high risk and planned treatment with anthracyclines and trastuzumab are given; also, measures aimed at preventing and correcting any modifiable risk factor are pointed out .
Collapse
|
47
|
Armenian SH, Lacchetti C, Barac A, Carver J, Constine LS, Denduluri N, Dent S, Douglas PS, Durand JB, Ewer M, Fabian C, Hudson M, Jessup M, Jones LW, Ky B, Mayer EL, Moslehi J, Oeffinger K, Ray K, Ruddy K, Lenihan D. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2017; 35:893-911. [DOI: 10.1200/jco.2016.70.5400] [Citation(s) in RCA: 652] [Impact Index Per Article: 93.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers. Methods Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review (1996 to 2016) of meta-analyses, randomized clinical trials, observational studies, and clinical experience. Study quality was assessed using established methods, per study design. The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology. Results A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. Recommendations It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy. Certain higher risk populations of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies. Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy. For certain higher risk survivors of cancer, routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy, so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction.
Collapse
Affiliation(s)
- Saro H. Armenian
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Christina Lacchetti
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Ana Barac
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Joseph Carver
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Louis S. Constine
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Neelima Denduluri
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Susan Dent
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Pamela S. Douglas
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Jean-Bernard Durand
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Michael Ewer
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Carol Fabian
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Melissa Hudson
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Mariell Jessup
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Lee W. Jones
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Bonnie Ky
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Erica L. Mayer
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Javid Moslehi
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Kevin Oeffinger
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Katharine Ray
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Kathryn Ruddy
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| | - Daniel Lenihan
- Saro H. Armenian, City of Hope, Duarte, CA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Ana Barac, Medstar Heart Institute, Medstar Washington Hospital Center, Washington, DC; Joseph Carver and Mariell Jessup, University of Pennsylvania; Bonnie Ky, Hospital of the University of Pennsylvania, Philadelphia, PA; Louis S. Constine, University of Rochester Medical Center, Rochester; Lee W. Jones and Kevin Oeffinger,
| |
Collapse
|
48
|
Abstract
Importance Oncocardiology is a medical discipline that focuses on the identification, prevention, and treatment of cardiovascular complications related to cancer therapy. This discipline has gained interest from the cardiology community in recent years because of a remarkable increase in the number of cancer survivors and the proliferation of new cancer therapies causing cardiovascular complications, such as hypertension, heart failure, vascular complications, and cardiac arrhythmia. In this review, we provide historical perspectives, highlight new discoveries, and speculate on the opportunity created by merging the research interests and clinical practices of cardiology and oncology. Observations The old paradigm of anthracycline cardiotoxic effects is replaced by new insights that anthracycline targets topoisomerase II β to cause DNA double-strand breaks and a profound change in the transcriptome leading to the generation of reactive oxygen species and the development of mitochondriopathy. Prevention of anthracycline cardiotoxic effects should be based on inhibiting or degrading topoisomerase II β. New challenges were posed by the introduction of trastuzumab and tyrosine kinase inhibitors that revolutionized cancer therapy. The on-target cardiotoxic effects of trastuzumab were owing to a prosurvival benefit of Her2 that binds to neuregulin, whereas the off-target effect of multitargeted tyrosine kinase inhibitors may be mediated by disruption of the vascular endothelial growth factor signaling pathway or the stress-induced angiogenesis. Sensitive imaging techniques, such as global strain, and biomarkers have allowed for early detection of cardiotoxic effects. Early treatment with heart failure medications may be beneficial in preventing the development of late cardiotoxic effects. Conclusions and Relevance Close collaboration between cardiologists and oncologists is required to meet the demand of an increasing number of cancer survivors. New insights based on mechanistic studies or genetic discoveries will pave the way for better prevention, diagnosis, and treatment of cancer therapy-induced cardiovascular complications.
Collapse
Affiliation(s)
- Edward T H Yeh
- Department of Internal Medicine, University of Missouri, Columbia2Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston
| | - Hui-Ming Chang
- Department of Internal Medicine, University of Missouri, Columbia
| |
Collapse
|
49
|
Biomarkers and Cancer Therapy-Related Cardiac Dysfunction. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0517-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
50
|
Cautela J, Lalevée N, Ammar C, Ederhy S, Peyrol M, Debourdeau P, Serin D, Le Dolley Y, Michel N, Orabona M, Barraud J, Laine M, Bonello L, Paganelli F, Barlési F, Thuny F. Management and research in cancer treatment-related cardiovascular toxicity: Challenges and perspectives. Int J Cardiol 2016; 224:366-375. [PMID: 27673693 DOI: 10.1016/j.ijcard.2016.09.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/01/2016] [Accepted: 09/15/2016] [Indexed: 12/19/2022]
Abstract
Cardiovascular toxicity is a potentially serious complication that can result from the use of various cancer therapies and can impact the short- and long-term prognosis of treated patients as well as cancer survivors. In addition to their potential acute cardiovascular adverse events, new treatments can lead to late toxicity even after their completion because patients who survive longer generally have an increased exposure to the cancer therapies combined to standard cardiovascular risk factors. These complications expose the patient to the risk of cardiovascular morbi-mortality, which makes managing cardiovascular toxicity a significant challenge. Cardio-oncology programs offer the opportunity to improve cardiovascular monitoring, safety, and management through a better understanding of the pathogenesis of toxicity and interdisciplinary collaborations. In this review, we address new challenges, perspectives, and research priorities in cancer therapy-related cardiovascular toxicity to identify strategies that could improve the overall prognosis and survival of cancer patients. We also focus our discussion on the contribution of cardio-oncology in each step of the development and use of cancer therapies.
Collapse
Affiliation(s)
- Jennifer Cautela
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean university Cardio-Oncology center (MEDI-CO center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Oncosafety Network of the Early Phases Cancer Trials Center (CLIP(2)), France; Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), France
| | - Nathalie Lalevée
- Aix-Marseille University, Technological Advances for Genomics and Clinics (TAGC), UMR/INSERM 1090, France
| | - Chloé Ammar
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean university Cardio-Oncology center (MEDI-CO center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Oncosafety Network of the Early Phases Cancer Trials Center (CLIP(2)), France; Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), France
| | - Stéphane Ederhy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Cardiology, Saint-Antoine Hospital, France
| | - Michael Peyrol
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean university Cardio-Oncology center (MEDI-CO center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Oncosafety Network of the Early Phases Cancer Trials Center (CLIP(2)), France; Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), France
| | - Philippe Debourdeau
- Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Sainte Catherine Institute, Department of Medical Oncology, Avignon, France
| | - Daniel Serin
- Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Sainte Catherine Institute, Department of Medical Oncology, Avignon, France
| | - Yvan Le Dolley
- Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Hôpital Saint Joseph, Department of Cardiology, Marseille, France
| | - Nicolas Michel
- Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Hôpital Saint Joseph, Department of Cardiology, Marseille, France
| | - Morgane Orabona
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean university Cardio-Oncology center (MEDI-CO center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Oncosafety Network of the Early Phases Cancer Trials Center (CLIP(2)), France; Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), France
| | - Jérémie Barraud
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean university Cardio-Oncology center (MEDI-CO center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Oncosafety Network of the Early Phases Cancer Trials Center (CLIP(2)), France; Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), France
| | - Marc Laine
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean university Cardio-Oncology center (MEDI-CO center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), France
| | - Laurent Bonello
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean university Cardio-Oncology center (MEDI-CO center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), France; Aix-Marseille University, INSERM, UMRS 1076, France
| | - Franck Paganelli
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean university Cardio-Oncology center (MEDI-CO center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), France; Aix-Marseille University, INSERM, UMRS 1076, France
| | - Fabrice Barlési
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Oncosafety Network of the Early Phases Cancer Trials Center (CLIP(2)), France; Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Aix-Marseille University, Multidisciplinary Oncology & Therapeutic Innovations Department, Assistance Publique - Hôpitaux de Marseille (AP-HM), Hôpital Nord, France
| | - Franck Thuny
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean university Cardio-Oncology center (MEDI-CO center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Oncosafety Network of the Early Phases Cancer Trials Center (CLIP(2)), France; Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Mediterranean Academic association for Research and Studies in Cardiology (MARS Cardio), France.
| |
Collapse
|