As reported to Chris Pirschel by Nonniekaye Shelburne, CRNP, MS, AOCN®
As the leading cause of death for adult Americans, cardiovascular disease is a complication found in many patients with cancer. Many cancer treatments have the potential to impact existing cardiac comorbidities or develop new cardiovascular conditions in patients undergoing treatment. Understanding and recognizing this issue is paramount for oncology nurses and is the focus of current research efforts impacting clinical practice.
The U.S. Food and Drug Administration is approving new cancer therapies at an accelerated rate. Yet, the impact that the new agents have on cardiac function may not be fully understood or studied during the approval process. In fact, oncology clinical trials typically exclude patients with pre-existing cardiac conditions, leading to a potential knowledge gap about the effects of certain drugs on patients with cancer presenting with a cardiovascular comorbidity.
It’s long been known that anthracycline, anti-HER2, and chest radiation therapies can cause cardiovascular issues. We’re learning more about how new immunotherapies, such as CDK4/6 and PD-1 inhibitors, impact heart function. Many other treatments may lead to cardiac complications, especially those that can cause hypertension, heart failure, arrhythmias, and thrombosis, among other side effects. And combination therapies have an even larger possibility to impact cardiovascular function on multiple levels. Identifying which patients are at risk before cancer treatment is initiated, what they’re at risk for, and how best to monitor for dysfunction are critical.
When it comes to cardiac-related oncologic emergencies, oncology nurses should be cognizant of issues such as hypertension and arrhythmias, which can be lethal. Moreover, when considering drugs like anthracyclines, contractility events can arise 10 or 20 years after treatment and can lead to early onset heart failure. So survivors have a risk of potential cardiovascular effects years down the road.
Oncology nurses need to recognize who’s at risk for those issues. The American Heart Association identifies risks from diabetes, obesity, hyperlipidemia, or a generally inactive lifestyle. Nurses are in a great position to discuss heart-related health issues with patients and provide education and interventions to curb risks of cardiac disease during and after cancer treatment.
The American Society of Clinical Oncology recently published Clinical Practice Guidelines on Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers that can be a particularly helpful resource for oncology nurses, especially for patients who have been treated with anthracycline. However, evidence is still lacking in the wider population of patients with cancer. Different treatments must be studied to better understand their cardiotoxic effects on patients, especially in an aging population of patients with cancer with existing comorbidities like cardiovascular disease. It’s crucial to be able to treat patients’ cancer without sacrificing their cardiac health.
For the cardio-oncology community, the overall goal is to mitigate cardiovascular disease while optimizing cancer treatments and outcomes throughout the care continuum. The National Institutes of Health (NIH), specifically the National Cancer Institute and National Heart, Lung, and Blood Institute, has been supporting research in this area for many years. I strongly encourage any of our interested oncology nurse researchers to develop and conduct studies in cancer treatment-related cardiotoxicity. NIH has funding for such programs at grants.nih.gov/grants/about_grants.htm. Ultimately in the future, we want to prevent cardiotoxicities, manage symptoms when they occur, and have a growing population of cancer survivors without treatment-related cardiovascular impairment.