CARDIO-ONCOLOGY: AN EMERGING SPECIALTY
Incidence rates for all combined cancers have risen by 13% in the last 25 years, and are projected to rise by a further 2% in the next 20 years.1 Advances in the treatment of malignant disease have led to increased survival in patients with cancer. However, mortality and morbidity related to cardiovascular side effects are becoming an increasing problem. In recognition of this, the specialty of cardio-oncology has developed rapidly over recent years, involving three distinct areas; the acute management of cardiovascular complications, for example, heart failure, arrhythmias, and acute coronary syndrome; the long-term screening of patients post-chemotherapy; and the planning of chemotherapeutic regimens in patients with established, or at high risk of, cardiovascular disease.
RANGE OF CARDIOTOXICITIES
The most commonly observed cardiovascular side effect of anticancer therapy is left ventricular (LV) dysfunction. This is most frequently associated with anthracyclines (dose-dependent effect) and the monoclonal antibody trastuzumab (Herceptin®).
The mechanism of anthracyline-induced cardiotoxicity is poorly understood, but is thought to be free radical-mediated, causing myocyte apoptosis and LV thinning.2 This leads to irreversible (type 1) LV impairment, which can occur acutely, or at an early (within first year of treatment) or late stage. …