Advancements in oncology have significantly improved survival rates for many types of cancer, leading to a growing population of long-term survivors [4], [7]. However, as cancer care evolves, clinicians and patients increasingly face the challenge of treatment-related side effects, particularly those affecting the cardiovascular system [4]. Understanding how therapies impact the heart is a vital part of comprehensive cancer care.
The Rise of Cardio-Oncology
The intersection of cancer treatment and heart health has given rise to a specialized field known as cardio-oncology [4]. Modern anticancer regimens—including traditional chemotherapy, targeted biological agents, immunotherapies, and radiation therapy—can sometimes lead to cancer therapy-related cardiovascular toxicity [4], [7], [8]. Because successful cancer management relies on balancing tumor control with overall patient safety, monitoring heart health has become an essential component of long-term survivorship [4].
Common Cardiovascular Complications
Cancer treatments can manifest in various cardiac conditions, ranging from acute changes during treatment to long-term chronic issues. Documented cardiovascular complications include:
- Heart failure and declines in left ventricular ejection fraction [1], [7]
- Cardiomyopathies, including stress-induced types [1]
- Arrhythmias and rhythm disturbances [1]
- Accelerated atherosclerotic disease and coronary artery disease [1], [8]
- Pericardial disease and inflammatory conditions like myocarditis [1]
Additionally, radiation therapy aimed at the chest, mediastinum, breast, lung, or esophagus can contribute to radiation-induced heart disease, a risk that may be intensified when combined with specific chemotherapeutic agents [2].
Overlapping Risk Factors and Pre-existing Conditions
Patients undergoing cancer treatment often present with pre-existing cardiovascular comorbidities, such as hypertension, diabetes mellitus, and established coronary heart disease [3]. Cancer and cardiovascular diseases frequently share overlapping, modifiable risk factors like smoking, obesity, poor diet, and physical inactivity, which can act synergistically to promote disease progression [8]. Furthermore, biological processes such as chronic inflammation and oxidative stress contribute to both oncological and cardiovascular challenges [8]. Managing these modifiable factors is critical, especially for elderly patients or those with a high burden of coexisting illnesses [3], [6].
Strategies for Surveillance and Management
Detecting cardiac toxicity early is crucial to preventing long-term damage. Conventionally, cardiotoxicity is identified by a drop in cardiac left ventricular ejection fraction measured through echocardiography [7]. However, researchers emphasize that once functional decline is clinically apparent, the cardiac damage may already be irreversible, driving the need for earlier diagnostic and metabolic markers [7]. Multidisciplinary care teams work closely to assess individual thrombotic and bleeding risks, manage modifiable risk factors like high blood pressure and blood sugar, and tailor treatment regimens—such as selecting therapies with lower cardiotoxic profiles when appropriate—to protect the patient's heart throughout their cancer journey [3].
Sources
- 1. Cardiotoxicity of Immune Checkpoint Inhibitors and Chimeric Antigen Receptor T-Cell Therapy
- 2. Radiation induced heart disease: Pathogenesis, management and review literature
- 3. Case Report: A case analysis of antitumor therapy and cardiovascular safety management in a breast cancer patient with multiple cardiovascular diseases
- 4. Cardio-oncology in multidisciplinary synergy: addressing the rising burden of cancer therapy-related cardiovascular toxicity (CTR-CVT) in advancing oncology practices
- 5. Neurologic complications of cancer chemotherapy
- 6. Cardiac Risk Without a Roadmap: Lack of Evidence-Based Guidance for Cardiovascular Toxicity of T-Cell Redirecting Therapies
- 7. Cancer Therapy-Induced Cardiotoxicity-A Metabolic Perspective on Pathogenesis, Diagnosis and Therapy
- 8. Coronary artery disease and cancer: Shared risk factors, pathogenesis, and treatment effects