CardiOncology dawns as specialty

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Cancer patients with cardiac problems might not be treated as aggressively as they could be by their cardiologists or oncologists because of a lack of evidence-based indications to guide treatment choices. Thus, the International CardiOncology Society was born in January 2009 to close the knowledge and treatment gaps in this patient population.

Cancer patients are living longer and are increasingly presenting with cardiac diseases. "In the future, an emphasis on 'personalized' therapy will continue to make collaboration between cardiologists and oncologists important," wrote Daniel J. Lenihana, MD, from Vanderbilt University in Nashville, Tenn. and colleagues from the University of Milan in Italy in the September/October issue of Progress in Cardiovascular Diseases.

For example, oncologists want to stymie vascular endothelial growth factor (VEGF) in cancer patients to limit tumor growth. Yet, VEGF can have beneficial effects for ischemic myocardium. "[E]ach new drug may have specific characteristics that result in unique toxicities," they wrote.

Stem cell therapy is another overlapping area of intense research by both oncologists and cardiologists, and a partnership between the two specialties "is essential" to establishing a better understanding of stem cell therapy for these patients.

Cardiologists already have added to the understanding of cardiac toxicity associated with anti-cancer drugs. Input from cardiology, for example, helped refine breast cancer treatment with trastuzumab, which initially had substantial cardiac-related toxicity.

Lenihana and colleagues wrote that input from cardiologists also helped manage cardiac problems associated with anthracyclines, "with a notable impact on patient outcomes."

The authors noted the importance of defining cardiovascular risk at the beginning of research protocols. "There is burgeoning evidence that cardiovasacular risk factors may have a substantial impact on the cardiac toxicity of cancer chemotherapeutic agents and the preventive treatment of cardiovascular-related comorbid conditions can have a significant benefit on all-cause mortality and cardiac-related outcomes."

The goals of the International CardiOncology Society include:

  • Eliminate cardiac disease as a barrier to cancer therapy;
  • Prevent the development of heart failure;
  • Establish a multi-institutional and international database;
  • Promote involvement of stakeholders in the development of clinical decisions with patient outcomes;
  • Develop web-based educational tools and interactive case study questions to provide ongoing clinical feedback to providers;
  • Develop the Common Terminology Criteria, version 4, to include sophisticated cardiac-based diagnostic tools, and ultimately, extend this common reporting criteria to cardiovascular clinical research; and
  • Disseminate practical multidisciplinary guidelines, which are lacking at the moment, for cardiac monitoring of cancer treatments.

"The clinicians and researchers involved in this effort have the ambitious task of investigating these scenarios and outlining new evidence-based guidelines. All this represents a big challenge and stimulating incentive for both the cardiologist and the oncologist," Lenihana and colleagues concluded.