[en] Aims: Anticancer therapies have extended the lives of millions of patients with malignancies, but for some this benefit is tempered by adverse cardiovascular (CV) effects. Cardiotoxicity may occur early or late after treatment initiation or termination. The extent of this cardiotoxicity is variable, depending on the type of drug used, combination with other drugs, mediastinal radiotherapy, the presence of CV risk factors, and comorbidities. A recent position paper from the European Society of Cardiology addressed the management of CV monitoring and management of patients treated for cancer. Methods and results: The current document is focused on the basis of the Cardio-Oncology (C-O) Services, presenting their rationale, organization, and implementation. C-O Services address the spectrum of prevention, detection, monitoring, and treatment of cancer patients at risk of cardiotoxicity and/or with concomitant CV diseases. These services require a multidisciplinary approach, with the aims of promoting CV health and facilitating the most effective cancer therapy. Conclusion: The expected growing volume of patients with cancer at risk of developing/worsening CV disease, the advent of new technological opportunities to refine diagnosis, and the necessity of early recognition of cancer therapy-related toxicity mandate an integrative multidisciplinary approach and care in a specialized environment. This document from the ESC Cardio-Oncology council proposes the grounds for creating C-O Services in Europe based on expert opinion.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Suter, Thomas M.
Lopez-Fernandez, Teresa
Galderisi, Maurizio
Lyon, Alexander R.
Van der Meer, Peter
Cohen Solal, Alain
Zamorano, Jose-Luis
Jerusalem, Guy ; Université de Liège - ULiège > Département des sciences cliniques > Oncologie
Cubbon RM, Lyon AR. Cardio-oncology: concepts and practice. Indian Heart J 2016;68 Suppl 1:S77–S85.
Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GYH, Lyon AR, Lopez Fernandez T, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM. 2016 ESC Position Paper cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016;37:2768–2801.
Borras JM, Albreht T, Audisio R, Briers E, Casali P, Esperou H, Grube B, Hamoir M, Henning G, Kelly J, Knox S, Nabal M, Pierotti M, Lombardo C, van Harten W, Poston G, Prades J, Sant M, Travado L, Valentini V, van de Velde C, van den Bogaert S, van den Bulcke M, van Hoof E, van den Neucker I, Wilson R. European Policy statement on multidisciplinary cancer care. European Partnership Action Against Cancer: consensus group. J Cancer 2014;50:475–480.
Parent S, Pituskin E, Paterson DI. The cardio-oncology program: a multidisciplinary approach to the care of cancer patients with cardiovascular disease. Can J Cardiol 2016;32:847–851.
Nancarrow SA, Booth A, Ariss S, Smith T, Enderby P, Roots A. Ten principles of good interdisciplinary team work. Hum Resour Health 2013;11:19.
Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2013;14:721–740.
Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, Ganame J, Sebag IA, Agler DA, Badano LP, Banchs J, Cardinale D, Carver J, Cerqueira M, DeCara JM, Edvardsen T, Flamm SD, Force T, Griffin BP, Jerusalem G, Liu JE, Magalhães A, Marwick T, Sanchez LY, Sicari R, Villarraga HR, Lancellotti P. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2014;15:1063–1093.
Herrmann J, Lerman A, Sandhu NP, Villarraga HR, Mulvagh SL, Kohli M. Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clin Proc 2014;89:1287–1306.
Tromp J, Steggink LC, Van Veldhuisen DJ, Gietema JA, van der Meer P. Cardio-oncology: progress in diagnosis and treatment of cardiac dysfunction. Clin Pharmacol Ther 2017;101:481–490.
López-Fernández T, Martín García A, Santaballa Beltrán A, Montero Luis Á, García Sanz R, Mazón Ramos P, Velasco Del Castillo S, López de Sá Areses E, Barreiro-Pérez M, Hinojar Baydes R, Pérez de Isla L, Valbuena López SC, Dalmau González-Gallarza R, Calvo-Iglesias F, González Ferrer JJ, Castro Fernández A, González-Caballero E, Mitroi C, Arenas M, Virizuela Echaburu JA, Marco Vera P, Íñiguez Romo A, Zamorano JL, Plana Gómez JC, López Sendón Henchel JL. Cardio-onco-hematology in clinical practice. Position paper and recommendations. Rev Esp Cardiol 2017;70:474–486.
der Meer P, Gietema JA, Suter TM, van Veldhuisen DJ. Cardiotoxicity of breast cancer treatment: no easy solution for an important long-term problem. Eur Heart J 2016;37:1681–1683.
Fennell ML, Das IP, Clauser S, Petrelli N, Salner A. The organization of multidisciplinary care teams: modelling internal and external influences on cancer care quality. J Nat Cancer Inst Monogr 2010;2010:72–80.
Barac A, Murtagh G, Carver JR, Chen MH, Freeman AM, Herrmann J, Iliescu C, Ky B, Mayer EL, Okwuosa TM, Plana JC, Ryan TD, Rzeszut AK, Douglas PS. Cardiovascular health of patients with cancer and cancer survivors: a roadmap to the next level. J Am Coll Cardiol 2015;65:2739–2746.
Henri C, Heinonen T, Tardif JC. The role of biomarkers in decreasing risk of cardiac toxicity after cancer therapy. Biomark Cancer 2016;8:39–45.
Okwuosa TM, Barac A. Burgeoning cardio-oncology programs: challenges and opportunities for early career cardiologists/faculty directors. J Am Coll Cardiol 2015;66:1193–1197.
Lancellotti P, Anker SD, Donal E, Edvardsen T, Popescu BA, Farmakis D, Filippatos G, Habib G, Maggioni AP, Jerusalem G, Galderisi M. EACVI/HFA Cardiac Oncology Toxicity Registry in breast cancer patients: rationale, study design, and methodology (EACVI/HFA COT Registry)–EURObservational Research Program of the European Society of Cardiology. Eur Heart J Cardiovasc Imaging 2015;16:466–470.
Lancellotti P, Galderisi M, Donal E, Edvardsen T, Popescu BA, Farmakis D, Filippatos G, Habib G, Lestuzzi C, Santoro C, Moonen M, Jerusalem G, Andarala M, Anker SD. Protocol update and preliminary results of EACVI/HFA Cardiac Oncology Toxicity (COT) Registry of the European Society of Cardiology. ESC Heart Fail 2017;4:312–318.