New perspectives in cardio-oncology
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New perspectives in cardio‑oncology Thomas D. Ryan1 · Salim S. Hayek2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
“We have so much time and so little to do! No! Wait!. Strike that! Reverse it!” –Roald Dahl, Charlie and the Great Glass Elevator
Cardio‑oncology: an ever‑expanding domain Despite regularly being referred to as a “new field,” the risks posed to the cardiovascular system by various therapies for conditions under the umbrella of hematology-oncology have been understood for many decades. Shortly after introduction of anthracyclines in the late 1960s, evidence began to accumulate that rhythmic, functional, and histologic abnormalities were present in exposed patients [1, 2]. As early as the mid-1970s, late effects of therapy were noted, and the idea that “cure is not enough” was proposed to address the various toxicities that could accompany treatment [3, 4]. Since then, it has become abundantly clear that all aspects of the cardiovascular system can be affected, as each new medication class introduced has been accompanied by reports of concomitant toxicities. Beyond the focused view on cancer and traditional cancer therapies, however, lie the cardiovascular effects of advanced therapies for cancer and marrow failure conditions such as hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy (CAR-T) [5]. * Thomas D. Ryan [email protected] * Salim S. Hayek [email protected] 1
2
Department of Pediatrics, University of Cincinnati College of Medicine; Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH 45229, USA Division of Cardiology, Department of Medicine, University of Michigan Frankel Cardiovascular Center, University of Michigan, 1500 E Medical Center Dr, CVC #2709, Ann Arbor, MI 48109, USA
What is the current state of the field? The unmet healthcare needs of an aging population with cancer and co-morbid cardiovascular disease have led to the rise of onco-cardiology, more commonly known as cardio-oncology [6, 7]. Formalized training programs to care for this population are rapidly emerging [8, 9], along with member sections of international organizations such as the American College of Cardiology and American Heart Association, and dedicated societies such as the International Cardio-Oncology Society, all focused on cardio-oncology. Close to a dozen surveillance and treatment guidelines have been published in the last 5 years alone [10–13], and two cardio-oncology specific journals have been established. While these efforts reflect the need and enthusiasm for cardio-oncology, the field is still nascent. Much of the guidance available is based on expert opinion or limited data studies. This is particularly true in pediatric patients. Evidence surrounding cardiotoxic effects of therapies are largely observational. High quality clinical trials demonstrating the effectiveness of screening, monitoring, preventive, and treatment strategies for cardiotoxicity are limited. As such, reco
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