Abstract
Improved cancer survivorship has resulted in a growing number of Canadians affected
by cancer and cardiovascular disease. As a consequence, cardio-oncology programs are
rapidly emerging to treat cancer patients with de novo and preexisting cardiovascular
disease. The primary goal of a cardio-oncology program is to preserve cardiovascular
health to allow the timely delivery of cancer therapy and achieve disease-free remission.
Multidisciplinary programs in oncology and cardiology have been associated with enhanced
patient well-being and improved clinical outcomes. Because of the complex needs of
these multisystem patients, a similar model of care is gaining acceptance. The optimal
composition of the cardio-oncology team will typically involve support from cardiology,
oncology, and nursing. Depending on the clinical scenario, additional consultation
from dietetics, pharmacy, and social services might be required. Timely access to
consultation and testing is another prerequisite for cardio-oncology programs because
delays in treating cardiac complications and nonadherence to prescribed cancer therapy
are each associated with poor outcomes. Recommended reasons for referral to cardio-oncology
programs include primary prevention for those at high risk for cardiotoxicity and
the secondary treatment of new or worsening cardiovascular disease in cancer patients
and survivors. Management is multifaceted and can involve lifestyle education, pharmacotherapy,
enhanced cardiovascular surveillance, and support services, such as exercise training.
The lack of evidence to guide clinical decisions and recommendations in cardio-oncology
is a major challenge and opportunity for health care professionals. Large multicentre
prospective registries are needed to adequately power risk model calculations and
generate hypotheses for novel interventions.
Résumé
L’amélioration de la survie au cancer a entraîné une augmentation du nombre de Canadiens
touchés par le cancer et par la maladie cardiovasculaire. Par conséquent, des programmes
de cardio-oncologie ont rapidement fait leur apparition afin de traiter les patients
atteints de cancer qui présentent une maladie cardiovasculaire nouvellement apparue
ou préexistante. Le principal objectif d’un programme de cardio-oncologie est de préserver
la santé cardiovasculaire pour permettre l’administration du traitement anticancéreux
dans les meilleurs délais et obtenir une rémission sans maladie. Des programmes multidisciplinaires
en oncologie et en cardiologie ont été associés à une amélioration du bien-être et
des résultats cliniques des patients. Compte tenu de la complexité des besoins de
ces patients présentant des atteintes multisystémiques, l’idée d’un modèle de soins
également multisystémique est de mieux en mieux acceptée. La composition optimale
d’une équipe de cardio-oncologie devra, de façon générale, inclure des spécialistes
en cardiologie, en oncologie et en soins infirmiers. Le soutien d’autres consultants
en diététique, en pharmacie et en services sociaux pourra être nécessaire en fonction
du scénario clinique. L’accès à des consultations et à des analyses dans les meilleurs
délais est un autre élément indispensable des programmes de cardio-oncologie, car
les retards dans le traitement des complications cardiaques et la non-observance du
traitement anticancéreux prescrit sont deux facteurs associés à des résultats défavorables.
Les raisons pour lesquelles il est recommandé d’orienter un patient à un programme
de cardio-oncologie sont notamment la prévention primaire dans les cas de risque élevé
de cardiotoxicité et le traitement secondaire d’une maladie cardiovasculaire nouvellement
apparue ou aggravée chez les patients atteints d’un cancer ou ayant survécu à un cancer.
La prise en charge multifacette peut comprendre de l’éducation sur les habitudes de
vie, une pharmacothérapie, une surveillance cardiovasculaire accrue et des services
de soutien, par exemple l’entraînement physique. L’absence de données probantes sur
lesquelles baser les décisions cliniques et les recommandations en cardio-oncologie
représente un enjeu majeur et une occasion importante pour les professionnels de la
santé. Ainsi, de vastes registres prospectifs multicentriques sont nécessaires pour
permettre les calculs adéquats d’un modèle de risque et pour générer des hypothèses
en vue de nouvelles interventions.
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Article info
Publication history
Published online: May 05, 2016
Accepted:
April 15,
2016
Received:
November 2,
2015
Footnotes
See page 850 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
