Stepping stones to improve cardio-oncological care

Abstract

Cardio-oncology is a new subspecialty which focuses on cardiovascular side effects of anticancer therapy. Cardiovascular effects consist of arrhythmias, pericardial-, valvular- or coronary artery disease. The risk of cardiovascular effects is predominantly determined by the type of anticancer treatment. One of the most important side effects is myocardial damage, which can lead to an impaired cardiac function. This impaired cardiac function can eventually can lead to heart failure.

This thesis describes methods for the establishment of specialized cardio-oncological care for patients at risk for cardiotoxic side effects due to anticancer treatment. One of the studies in this thesis describes the added value of specialized cardiac care for cancer patients. Two other studies focus on the cardiotoxic effects of a number of anticancer treatments. Another study describes the design of ONCOR, the Dutch Cardio-Oncology Registry. This registry collects data of patients who have received care at specialized cardio-oncology clinics. The ONCOR registry has been implemented in several Dutch hospitals and outcomes can be helpful in the improvement of cardio-oncology care.

An important finding from the thesis is that the majority of patients with cancer therapy-induced myocardial damage do not experience cardiac complaints. This side-effect can therefore remain undetected in the absence of cardiac screening. Early identification can be beneficial, as one study found that patients with early identification of cardiac dysfunction showed better improvement of cardiac function after initiation of heart failure therapy.