Elsevier

Annals of Oncology

Volume 31, Issue 2, February 2020, Pages 171-190
Annals of Oncology

Special Article
Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations

https://doi.org/10.1016/j.annonc.2019.10.023Get rights and content
Under an Elsevier user license
open archive

Highlights

  • This consensus article provides guidance on prevention, screening, monitoring and treatment of cardiovascular toxicities.

  • Authorship includes a multidisciplinary group of experts from different institutions and countries in Europe and abroad.

  • Cardiovascular toxicities of cancer therapies can have significant impact on cancer patients' morbidity and mortality.

  • A multidisciplinary approach to the cardiovascular care of cancer patients is essential to achieve optimal long-term outcomes.

  • A summary of recommendations is provided, including levels of evidence and grades of recommendation where applicable.

Cancer and cardiovascular (CV) disease are the most prevalent diseases in the developed world. Evidence increasingly shows that these conditions are interlinked through common risk factors, coincident in an ageing population, and are connected biologically through some deleterious effects of anticancer treatment on CV health. Anticancer therapies can cause a wide spectrum of short- and long-term cardiotoxic effects. An explosion of novel cancer therapies has revolutionised this field and dramatically altered cancer prognosis. Nevertheless, these new therapies have introduced unexpected CV complications beyond heart failure. Common CV toxicities related to cancer therapy are defined, along with suggested strategies for prevention, detection and treatment. This ESMO consensus article proposes to define CV toxicities related to cancer or its therapies and provide guidance regarding prevention, screening, monitoring and treatment of CV toxicity. The majority of anticancer therapies are associated with some CV toxicity, ranging from asymptomatic and transient to more clinically significant and long-lasting cardiac events. It is critical however, that concerns about potential CV damage resulting from anticancer therapies should be weighed against the potential benefits of cancer therapy, including benefits in overall survival. CV disease in patients with cancer is complex and treatment needs to be individualised. The scope of cardio-oncology is wide and includes prevention, detection, monitoring and treatment of CV toxicity related to cancer therapy, and also ensuring the safe development of future novel cancer treatments that minimise the impact on CV health. It is anticipated that the management strategies discussed herein will be suitable for the majority of patients. Nonetheless, the clinical judgment of physicians remains extremely important; hence, when using these best clinical practices to inform treatment options and decisions, practitioners should also consider the individual circumstances of their patients on a case-by-case basis.

Key words

cardiac disease
cardiovascular toxicity
Clinical Practice Guidelines
diagnosis
recommendations

Cited by (0)

Contributed equally as first authors.