Skip to main content
SpringerLink
Log in

Cardio-Oncology

  • Chapter
  • First Online:
Handbook of Outpatient Cardiology

  • 1215 Accesses

Abstract

As cancer survivorship continues to increase, the associated cardiovascular effects of cancer therapies have become more commonly encountered by providers, both during and after treatment. This chapter discusses the risk factors, diagnosis, and management of common cardiovascular complications of cancer therapies. Risk factor management and identification of at-risk patients is critical to care of this patient population.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

5-FU:

5-Fluorouracil

ACE-i:

Angiotensin-converting enzyme inhibitor

AF:

Atrial fibrillation

AFL:

Atrial flutter

ARB:

Angiotensin receptor blocker

CT:

Computed tomography

CV:

Cardiovascular

CVD:

Cardiovascular disease

HER2:

Human epidermal growth factor receptor 2

LVEF:

Left ventricular ejection fraction

MRI:

Magnetic resonance imaging

PAD:

Peripheral arterial disease

VEGF:

Vascular endothelial growth factor

References

  1. Shapiro CL. Cancer Survivorship. 2018;379(25):2438–50.

    Google Scholar 

  2. de Azambuja E, Ameye L, Diaz M, Vandenbossche S, Aftimos P, Bejarano Hernandez S, et al. Cardiac assessment of early breast cancer patients 18 years after treatment with cyclophosphamide-, methotrexate-, fluorouracil- or epirubicin-based chemotherapy. Eur J Cancer (Oxford, England: 1990). 2015;51(17):2517–24.

    Google Scholar 

  3. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC position paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for practice guidelines:  the task force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(36):2768–801.

    Article  PubMed  Google Scholar 

  4. Barac A, Murtagh G, Carver JR, Chen MH, Freeman AM, Herrmann J, et al. Cardiovascular health of patients with cancer and cancer survivors: a roadmap to the next level. J Am Coll Cardiol. 2015;65(25):2739–46.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cardinale D, Colombo A, Lamantia G, Colombo N, Civelli M, De Giacomi G, et al. Anthracycline-induced cardiomyopathy: clinical relevance and response to pharmacologic therapy. J Am Coll Cardiol. 2010;55(3):213–20.

    Article  CAS  PubMed  Google Scholar 

  6. Cardinale D, Colombo A, Bacchiani G, Tedeschi I, Meroni CA, Veglia F, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation. 2015;131(22):1981–8.

    Article  CAS  PubMed  Google Scholar 

  7. Armstrong GT, Plana JC, Zhang N, Srivastava D, Green DM, Ness KK, et al. Screening adult survivors of childhood cancer for cardiomyopathy: comparison of echocardiography and cardiac magnetic resonance imaging. J Clin Oncol. 2012;30(23):2876–84.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hequet O, Le QH, Moullet I, Pauli E, Salles G, Espinouse D, et al. Subclinical late cardiomyopathy after doxorubicin therapy for lymphoma in adults. J Clin Oncol. 2004;22(10):1864–71.

    Article  CAS  PubMed  Google Scholar 

  9. Steinherz LJ, Steinherz PG, Tan CT, Heller G, Murphy ML. Cardiac toxicity 4 to 20 years after completing anthracycline therapy. JAMA. 1991;266(12):1672–7.

    Article  CAS  PubMed  Google Scholar 

  10. Cardinale D, Sandri MT. Role of biomarkers in chemotherapy-induced cardiotoxicity. Prog Cardiovasc Dis. 2010;53(2):121–9.

    Article  CAS  PubMed  Google Scholar 

  11. Ledwidge M, Gallagher J, Conlon C, Tallon E, O'Connell E, Dawkins I, et al. Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial. JAMA. 2013;310(1):66–74.

    Article  CAS  PubMed  Google Scholar 

  12. Mitani I, Jain D, Joska TM, Burtness B, Zaret BL. Doxorubicin cardiotoxicity: prevention of congestive heart failure with serial cardiac function monitoring with equilibrium radionuclide angiocardiography in the current era. J Nuclear Cardiol: Official Publication of the American Society of Nuclear Cardiology. 2003;10(2):132–9.

    Article  Google Scholar 

  13. Mahmood SS, Fradley MG, Cohen JV, Nohria A, Reynolds KL, Heinzerling LM, et al. Myocarditis in patients treated with immune checkpoint inhibitors. J Am Coll Cardiol. 2018;71(16):1755–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Frickhofen N, Beck FJ, Jung B, Fuhr HG, Andrasch H, Sigmund M. Capecitabine can induce acute coronary syndrome similar to 5-fluorouracil. Annals of Oncology: Official Journal of the European Society for Medical Oncology. 2002;13(5):797–801.

    Article  CAS  Google Scholar 

  15. Choueiri TK, Schutz FA, Je Y, Rosenberg JE, Bellmunt J. Risk of arterial thromboembolic events with sunitinib and sorafenib: a systematic review and meta-analysis of clinical trials. J Clin Oncol. 2010;28(13):2280–5.

    Article  CAS  PubMed  Google Scholar 

  16. Hull MC, Morris CG, Pepine CJ, Mendenhall NP. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of hodgkin lymphoma treated with radiation therapy. JAMA. 2003;290(21):2831–7.

    Article  CAS  PubMed  Google Scholar 

  17. Moore RA, Adel N, Riedel E, Bhutani M, Feldman DR, Tabbara NE, et al. High incidence of thromboembolic events in patients treated with cisplatin-based chemotherapy: a large retrospective analysis. J Clin Oncol. 2011;29(25):3466–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. McEniery PT, Dorosti K, Schiavone WA, Pedrick TJ, Sheldon WC. Clinical and angiographic features of coronary artery disease after chest irradiation. Am J Cardiol. 1987;60(13):1020–4.

    Article  CAS  PubMed  Google Scholar 

  19. Virmani R, Farb A, Carter AJ, Jones RM. Comparative pathology: radiation-induced coronary artery disease in man and animals. Seminars in Intervent Cardiol: SIIC. 1998;3(3–4):163–72.

    CAS  Google Scholar 

  20. McGale P, Darby SC, Hall P, Adolfsson J, Bengtsson NO, Bennet AM, et al. Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiothera Oncol: J Eur Soc Therapeut Radiol Oncol. 2011;100(2):167–75.

    Article  Google Scholar 

  21. Kosmas C, Kallistratos MS, Kopterides P, Syrios J, Skopelitis H, Mylonakis N, et al. Cardiotoxicity of fluoropyrimidines in different schedules of administration: a prospective study. J Cancer Res Clin Oncol. 2008;134(1):75–82.

    Article  CAS  PubMed  Google Scholar 

  22. Lancellotti P, Nkomo VT, Badano LP, Bergler J, Bogaert J, Davin L, et al. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26(9):1013–32.

    Article  PubMed  Google Scholar 

  23. Xu XR, Yousef GM, Ni H. Cancer and platelet crosstalk: opportunities and challenges for aspirin and other antiplatelet agents. 2018;131(16):1777–89.

    Google Scholar 

  24. Hering D, Faber L, Horstkotte D. Echocardiographic features of radiation-associated valvular disease. Am J Cardiol. 2003;92(2):226–30.

    Article  PubMed  Google Scholar 

  25. Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2014;15(10):1063–93.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Groarke JD, Nguyen PL, Nohria A, Ferrari R, Cheng S, Moslehi J. Cardiovascular complications of radiation therapy for thoracic malignancies: the role for non-invasive imaging for detection of cardiovascular disease. Eur Heart J. 2014;35(10):612–23.

    Article  PubMed  Google Scholar 

  27. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the Management of Patients with Valvular Heart Disease. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2017;70(2):252–89.

    Google Scholar 

  28. Tamargo J, Caballero R, Delpon E. Cancer chemotherapy and cardiac arrhythmias: a review. Drug Saf. 2015;38(2):129–52.

    Article  CAS  PubMed  Google Scholar 

  29. Soignet SL, Frankel SR, Douer D, Tallman MS, Kantarjian H, Calleja E, et al. United States multicenter study of arsenic trioxide in relapsed acute promyelocytic leukemia. J Clin Oncol. 2001;19(18):3852–60.

    Article  CAS  PubMed  Google Scholar 

  30. Shah RR, Morganroth J, Shah DR. Cardiovascular safety of tyrosine kinase inhibitors: with a special focus on cardiac repolarisation (QT interval). Drug Saf. 2013;36(5):295–316.

    Article  CAS  PubMed  Google Scholar 

  31. Chandrasekhar S, Fradley MGJCTOIO. QT interval prolongation associated with cytotoxic and targeted cancer therapeutics. 2019;20(7):55.

    Google Scholar 

  32. Lenihan DJ, Kowey PR. Overview and management of cardiac adverse events associated with tyrosine kinase inhibitors. Oncologist. 2013;18(8):900–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Farmakis D, Parissis J, Filippatos G. Insights into onco-cardiology: atrial fibrillation in cancer. J Am Coll Cardiol. 2014;63(10):945–53.

    Article  PubMed  Google Scholar 

  34. Izzedine H, Ederhy S, Goldwasser F, Soria JC, Milano G, Cohen A, et al. Management of hypertension in angiogenesis inhibitor-treated patients. Annals of Oncology : Official Journal of the European Society for Medical Oncology. 2009;20(5):807–15.

    Article  CAS  Google Scholar 

  35. Maitland ML, Bakris GL, Black HR, Chen HX, Durand JB, Elliott WJ, et al. Initial assessment, surveillance, and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors. J Natl Cancer Inst. 2010;102(9):596–604.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Rickles FR. Mechanisms of cancer-induced thrombosis in cancer. Pathophysiol Haemost Thromb. 2006;35(1–2):103–10.

    Article  PubMed  Google Scholar 

  37. Lee AYY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, et al. Low-Molecular-Weight Heparin versus a Coumarin for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer. 2003;349(2):146–53.

    CAS  Google Scholar 

  38. Agnelli G, Becattini C, Meyer G, Muñoz A, Huisman MV, Connors JM, et al. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med. 2020;382(17):1599–607.

    Article  CAS  PubMed  Google Scholar 

  39. Barginear MF, Gralla RJ, Bradley TP, Ali SS, Shapira I, Greben C, et al. Investigating the benefit of adding a vena cava filter to anticoagulation with fondaparinux sodium in patients with cancer and venous thromboembolism in a prospective randomized clinical trial. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer. 2012;20(11):2865–72.

    Article  Google Scholar 

  40. Valent P, Hadzijusufovic E, Schernthaner GH, Wolf D, Rea D, le Coutre P. Vascular safety issues in CML patients treated with BCR/ABL1 kinase inhibitors. Blood. 2015;125(6):901–6.

    Article  CAS  PubMed  Google Scholar 

  41. De Bruin ML, Dorresteijn LD, van't Veer MB, Krol AD, van der Pal HJ, Kappelle AC, et al. Increased risk of stroke and transient ischemic attack in 5-year survivors of Hodgkin lymphoma. J Natl Cancer Inst. 2009;101(13):928–37.

    Article  PubMed  Google Scholar 

  42. Plummer C, Henderson RD, O'Sullivan JD, Read SJ. Ischemic stroke and transient ischemic attack after head and neck radiotherapy: a review. Stroke. 2011;42(9):2410–8.

    Article  PubMed  Google Scholar 

  43. Fokkema M, den Hartog AG, Bots ML, van der Tweel I, Moll FL, de Borst GJ. Stenting versus surgery in patients with carotid stenosis after previous cervical radiation therapy: systematic review and meta-analysis. Stroke. 2012;43(3):793–801.

    Article  PubMed  Google Scholar 

  44. Gujral DM, Shah BN, Chahal NS, Senior R, Harrington KJ, Nutting CM. Clinical features of radiation-induced carotid atherosclerosis. Clinical Oncol (Royal College of Radiologists (Great Britain)). 2014;26(2):94–102.

    Google Scholar 

  45. Limsuwan A, Pakakasama S, Rochanawutanon M, Hong-eng S. Pulmonary arterial hypertension after childhood cancer therapy and bone marrow transplantation. Cardiology. 2006;105(3):188–94.

    Article  PubMed  Google Scholar 

  46. Montani D, Bergot E, Gunther S, Savale L, Bergeron A, Bourdin A, et al. Pulmonary arterial hypertension in patients treated by dasatinib. Circulation. 2012;125(17):2128–37.

    Article  CAS  PubMed  Google Scholar 

  47. Montani D, Bergot E, Günther S, Savale L, Bergeron A, Bourdin A, et al. Pulmonary arterial hypertension in patients treated by Dasatinib. Circulation. 2012;125(17):2128–37.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Devinder S. Dhindsa & Anant Mandawat

  2. Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA

    Anant Mandawat

Authors
  1. Devinder S. Dhindsa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anant Mandawat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Devinder S. Dhindsa .

Editor information

Editors and Affiliations

  1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Ankit A. Bhargava

  2. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Bryan J. Wells

  3. Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Pablo A. Quintero

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dhindsa, D.S., Mandawat, A. (2022). Cardio-Oncology. In: Bhargava, A.A., Wells, B.J., Quintero, P.A. (eds) Handbook of Outpatient Cardiology . Springer, Cham. https://doi.org/10.1007/978-3-030-88953-1_31

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-88953-1_31

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-88952-4

  • Online ISBN: 978-3-030-88953-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation