"I am here for breast cancer. Why do you speak to me about my heart?

Many doctors do not talk about the risks of cardiotoxicity of treatment to cancer patients and may not be fully aware of the dangers themselves. A new study reveals an urgent need to heal the hearts of these patients. The research is being presented today at EuroHeartCare 2019, a scientific congress of the European Society of Cardiology (ESC).

"There was no mention that it could lead to heart disease, it would have been nice to know."

The growing number of cancer survivors and the growing number of people over the age of 65 requiring chronic cancer treatment are increasing the need for cardio-oncology services. Heart failure caused by cancer treatment can occur up to 20 years after treatment. In 2012, more than 32 million people around the world were living with cancer.

"Depending on the type of chemotherapy and radiation therapy, between 1% and 25% of cancer patients may develop heart failure due to an anticancer treatment," said Professor Robyn Clark, author of the study, from Flinders University of Adelaide, Australia. "The risk also depends on cardiovascular risk factors such as smoking and obesity.A better heart control and intervention before, during and after treatment can prevent or mitigate the impact of this cardiotoxicity."

The researchers reviewed the medical records of 46 randomly selected cancer patients with cardiotoxicity who had attended one of the three hospitals between 1979 and 2015. Only 11% were referred to a cardiologist prior to chemotherapy and less half (48%) were sent to a clinic for heart failure cancer treatment. Nearly 40% of overweight or obese people, 41% of current smokers or former smokers, 24% of regular alcohol users, 48% of hypertensives and 26% of those with diabetes.

In a subgroup of patients, the practice was compared before (1994-2011) and after (2012-2015), the 2012 guidelines of the European Society of Medical Oncology were published. Guidance to a cardiologist prior to chemotherapy increased from 0 to 23% and completion of an initial heart echocardiogram went from 57% to 77%.

Eleven patients were interviewed, seven of whom participated in the badysis of medical records. No patient could express his needs for heart health. More than half said they started eating healthy after diagnosing their cancer, but did not seem to understand a balanced diet.

The CES published recommendations in 2016 and in 2018 launched the CES Cardio-Oncology Council to promote the prevention, early diagnosis and management of cardiovascular diseases related to cancer treatment. Patients should be informed of heart risks before starting cancer treatment, helped to stop smoking, eat healthy, exercise and control their weight, and report the signs and symptoms of cardiovascular disease.

Cardiotoxicity is detected using an electrocardiogram (ECG), cardiac imaging and biomarkers. The frequency of evaluation depends on a number of factors – for example, an badessment of coronary artery disease, ischemia and vascular disease is recommended in patients with a history of mediastinal radiation. starting five years after treatment, then at least every five years thereafter. they have no symptoms.

Angiotensin converting enzyme (ACE) inhibitors or beta-blockers may be administered to prevent or treat heart failure. And the anticancer therapy can be modified, for example by reducing the dose or leaving a space between two agents that increase the risk of heart failure when they are taken together (for example, anthracyclines and trastuzumab) .

"Monitoring the heart throughout cancer progression can ensure its protection," said Professor Clark. "Cardiotoxicity can occur even in people without cardiovascular risk factors, because drugs such as anthracyclines and trastuzumab are toxic to the heart, so it's an innocent witness."

"For cancer patients who develop heart failure, there are clinics that will improve their quality of life, but our study shows that many are not referred," she added. "Phone calls to support and monitor people with cancer and heart failure would reduce the burden of appointments at the hospital, which patients saw as a priority."