Cancer therapy has become more sophisticated and effective, resulting in an ever-expanding group of long-term cancer survivors over the last 20 years.
There is also a growing awareness of the potentially negative effects of cancer treatment on the heart and the management of cardiac disease during and after cancer therapy. In the September/October issue of Progress in Cardiovascular Diseases an international group of experts takes an in-depth look at the ways in which cancer treatment profoundly impacts patients' cardiovascular function and can become a major detriment of overall survival.
Guest Editors of this issue, Douglas L. Mann, MD, and Ronald J. Krone, MD, both of the Division of Cardiology, Washington University School of Medicine, St. Louis, put the situation into perspective. "The management of heart disease in all its forms in patients with cancer in all its forms presents special challenges to the cardiologist. In the war on cancer, the cardiologist is not in the front lines, directly confronting the enemy, but in the role of support and supply, providing the oncologist the ability to keep the warrior strong enough to defeat the enemy. In fighting the war on cancer, there is, like in any war, unwanted 'collateral damage.' There is no 'silver bullet' but, in many ways, a refined shotgun, blasting the tumor while pellets hit other vital organs. The bone marrow, liver, and nervous system get their share of hits; but the heart and vascular system are certainly at risk depending on the weapon used, particularly because the vascular system and blood supply are intimately involved in any treatment delivery. Just as in a war, not only must the enemy be destroyed; but the damage must be contained to permit the rebuilding of the homeland."
"The recent recognition of the frequent collateral damage of the heart from many of the newer chemotherapeutic agents, as well as the classic anthracyclines, and the importance of this to management of the cancer, should spur the acquisition of cardiac outcomes data and ultimately trigger the development of specific evidence-based practice guidelines to keep the heart from interfering with the war on cancer," commented Dr. Mann and Dr. Krone.