Abstract
More than 80% of children and 60% of adults with cancer will become long-term survivors,
emphasizing the importance of late effects of cancer therapy. Cardiotoxicity due to
chemotherapy and radiation is a frequent cause of serious morbidity and premature
mortality in survivors. Anthracyclines, a core component of many treatment regimens,
have been implicated as a principal cause of irreversible cardiomyopathy. Approximately
60% of anthracycline-treated children will develop echocardiographic evidence of cardiac
dysfunction, and 10% of those treated with high-dose anthracyclines will develop congestive
heart failure within the 20 years after therapy. Adults treated with trastuzumab are
at risk of a cardiomyopathy that is usually reversible. As many as 12% of adults treated
with trastuzumab and 20% of those who have also received an anthracycline will develop
cardiotoxicity within 5 years. Risk factors for cardiomyopathy include patient (eg,
age, sex, genetic predisposition) and treatment characteristics (eg, cumulative anthracycline
dose). Radiotherapy to a field involving the heart increases the risk of cardiomyopathy,
coronary artery disease, valvular dysfunction, arrhythmias, and pericardial disease.
Surveillance guidelines are available to guide long-term cardiac follow-up of childhood
cancer survivors, but not for survivors of adult cancers; however, periodic follow-up
to detect cardiac dysfunction may be reasonable. Modifiable cardiac risk factors such
as hypertension, smoking, and dyslipidemia interact with cancer therapies to increase
the risk of cardiac disease, emphasizing the importance of risk-factor control. Coordination
of care between oncologists and cardiologists would optimize care for those individuals
at high risk of cardiotoxicity who would benefit from appropriate surveillance and
treatment strategies.
Résumé
Plus de 80 % des enfants et 60 % des adultes atteints de cancer y survivront à long
terme, ce qui met en évidence l’importance des effets retards du traitement anticancéreux.
La cardiotoxicité causée par la chimiothérapie et la radiothérapie est une cause fréquente
de morbidité grave et de mortalité précoce chez les survivants. Les anthracyclines,
une composante importante de nombreux schémas thérapeutiques, ont été pointées du
doigt comme principale cause de la cardiomyopathie irréversible. Environ 60 % des
enfants traités par des anthracyclines présenteront des signes de dysfonction cardiaque
à l’échographie et 10 % des patients ayant reçu de fortes doses d’anthracyclines seront
atteints d’une insuffisance cardiaque dans les 20 années suivant le traitement. Les
adultes traités par le trastuzumab sont exposés à un risque de cardiomyopathie habituellement
réversible. Jusqu’à 12 % des adultes traités par le trastuzumab et 20 % de ceux ayant
également reçu une anthracycline présenteront une cardiotoxicité dans les 5 ans. Les
facteurs de risque de cardiomyopathie comprennent les caractéristiques du patient
(par ex., âge, sexe, prédispositions génétiques) et du traitement (p. ex., dose cumulative
d’anthracycline). La radiothérapie ciblant une région où se trouve le cœur augmente
le risque de cardiomyopathie, de coronaropathie, de dysfonction valvulaire, d’arythmies
et de maladie péricardique. Il existe des lignes directrices en matière de surveillance
qui permettent d’orienter le suivi cardiaque à long terme chez les personnes ayant
survécu à un cancer dans l’enfance, mais non chez celles ayant survécu à un cancer
à l’âge adulte; ainsi, un suivi à intervalles réguliers pour dépister toute dysfonction
cardiaque pourrait être une pratique raisonnable. Les facteurs de risque modifiables
de maladie cardiaque, tels que l’hypertension, l’usage du tabac et la dyslipidémie,
interagissent avec les traitements anticancéreux et augmentent, de ce fait, le risque
de maladie cardiaque. La prise en charge de ces facteurs de risque revêt donc une
importance accrue. La coordination des soins entre l’oncologue et le cardiologue optimiserait
les soins chez les personnes exposées à un risque élevé de cardiotoxicité qui pourraient
bénéficier d’une surveillance et de stratégies thérapeutiques appropriées.
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Article info
Publication history
Published online: March 01, 2016
Accepted:
February 22,
2016
Received:
November 24,
2015
Footnotes
See page 877 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
