Heart-related side effects of cancer treatment must be addressed as early as possible, warns study

The devastating news of a cancer diagnosis understandably makes doctors and patients focus on the cancer itself. However, experts in cardio-oncology from the European Society of Cardiology (ESC) emphasise that heart and cardiovascular health must be included as early as possible in the patient’s cancer treatment plan to ensure the best possible outcomes.

Due to an ageing population, and a growing number of cancer diagnoses there is also an increasing number of patients with cardiovascular side effects of cancer treatment. To tackle this growing problem, the ESC is launching a new conference on cardio-oncology to specifically target this increasingly important area that overlaps cancer treatment and its associated cardiovascular disease (CVD) side effects. ESC Cardio-Oncology 2025 will take place in Florence, Italy, from Friday, 20 June - Saturday, 21 June 2025.

Previous research from prospective registries published in the European Heart Journal estimate that approximately one-third (32%) of patients experience mild toxicities that could potentially progress in severity without adequate monitoring, while 3% develop moderate toxicity and a further 3% the most severe toxicity.

“The main goal of this emerging specialty of cardio-oncology is to reduce the burden of CVD in cancer patients allowing them to receive the best anticancer therapy (chemotherapy, targeted molecular therapies, hormone therapy, immunotherapy or radiotherapy) with the lowest rate of side effects and treatment interruptions,” explains Dr Teresa López-Fernandez, University Hospital La Paz - Madrid, Spain and co-Chair of the ESC Cardio-Oncology Guidelines Task Force.

“We could soon be facing cardio-oncology ‘epidemic’ due to either the growing population of cancer survivors, the increasing number of patients aged over 65 who need chronic cancer therapy, and the high frequency of cancer therapy induced CVDs in these populations,” says Dr Alexander Lyon, Royal Brompton Hospital, London, UK, and also co-Chair of the ESC Cardio-Oncology Guidelines Task Force.

Concerns about the increasing prevalence of cardiotoxicity caused by cancer therapies led to the ESC establishing, in 2018, the Council of Cardio-Oncology as a multidisciplinary constituent body which encourages the prevention, early diagnosis and management of cancer therapy-related CVD. Today, the council brings together over 2,000 members worldwide and a team of volunteers part of the Council of Cardio-Oncology Board.

In 2022, the Guidelines Taskforce, led by Drs López-Fernandez and Lyon, published the first ever ESC Clinical Practice Guidelines on cardio-oncology . These guidelines include advice on how to conduct an assessment of cardiovascular toxicity risk, in collaboration with the cardio-oncology team, using specific risk scores; the implementation of preventive strategies in high-risk patients; and analysis of methods to monitor cancer treatments with advanced cardiac imaging techniques (including MRI and strain) and biomarkers.

They also include techniques of early management of potential cardiac toxicities, aiming to maintain cancer treatment whenever cardiac toxicity is manageable, and the patient remains stable; and also, advice on carrying out long-term follow-up of cancer survivors who have received treatments with potential late cardiovascular effects.

"Cardio-oncology teams design effective 'shields' to protect the hearts of oncology patients," says Dr López-Fernandez. “The teamwork between cardiologists and cancer specialists promotes the prevention of cardiovascular diseases in cancer survivors.”

The Guidelines provide highly detailed explanations of cancer therapy-related CV toxicity (CTR-CVT), and various examples of this including cardiac dysfunction, arrhythmias, hypertension (arterial and pulmonary), thrombosis. If cardiac dysfunction is detected, cardiology and oncology teams are strongly recommended to discuss the pros and cons of continuing versus stopping cancer treatment. Dr Lyon comments: “Our mission is always to ensure that cancer patients have the best and most effective cancer treatment safely, and to prevent interruptions in their cancer treatment due to cardiovascular problems which could have been prevented.”

Populations needing special considerations, including children and adolescents and pregnant women with cancer, are also all addressed in the Guidelines. “As the global population grows older, we will see more and more people with cancer and thus more and more with toxic CVD side-effects of cancer treatment,” says Dr López-Fernandez. Dr Lyon adds: “This specialised area of medicine is one that is only going to grow, and as such we and other experts at the European Society of Cardiology believe the time has come to have a global forum, in the form of our first ever ESC Cardio-Oncology conference, to gather global experts to ensure better outcomes for this growing patient group.”

Reference:

José López-Sendón, Carlos Álvarez-Ortega, Pilar Zamora Auñon, Antonio Buño Soto, Alexander R Lyon, Dimitrios Farmakis, Daniela Cardinale, Miguel Canales Albendea, Jaime Feliu Batlle, Isabel Rodríguez Rodríguez, Olaia Rodríguez Fraga, Ainara Albaladejo, Guiomar Mediavilla, Jose Ramón González-Juanatey, Amparo Martínez Monzonis, Pilar Gómez Prieto, José González-Costello, J on behalf of the CARDIOTOX Registry Investigators, Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry, European Heart Journal, Volume 41, Issue 18, 7 May 2020, Pages 1720–1729, https://doi.org/10.1093/eurheartj/ehaa006