Late Cardiac Effects of Cancer Treatment

2012 ◽  
Vol 30 (30) ◽  
pp. 3657-3664 ◽  
Author(s):  
Daniel J. Lenihan ◽  
Daniela M. Cardinale
Keyword(s):  
Cancer Therapy ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Imaging Techniques ◽  
Cardiovascular Complications ◽  
Cardiac Biomarkers ◽  
Cardiac Imaging Techniques ◽  
Future Research ◽  
Cardiac Effects ◽  
Structural Problems

Cardiac toxicities from cancer therapy can become evident many years after treatment, and these late cardiac effects can have a profound impact on cancer survivors. There are a myriad of potential cardiovascular complications from cancer therapy, but these can be grouped into three main categories. First, vascular conditions including atherosclerosis, thrombosis, and hypertension predominate. Second, cardiac structural problems, especially valvular degeneration, can have a dramatic impact long term. Lastly, and most importantly, cardiac dysfunction and heart failure are potentially common late cardiac effects and can certainly be prevented or detected early during active cancer therapy to result in optimal outcomes. Future research on late cardiac effects in cancer survivors needs to include advanced cardiac imaging techniques, novel cardiac biomarkers, and genetic determinants of response to cancer treatment.

Cancer and Cancer Treatment-Related Cognitive Impairment

2019 ◽  
pp. 60-83
Author(s):  
James C.  Root ◽  
Elizabeth Ryan ◽  
Tim A. Ahles
Keyword(s):  
Cancer Survivors ◽  
Cancer Treatment ◽  
Clinical Presentation ◽  
Functional Neuroimaging ◽  
Theoretical Models ◽  
Future Research ◽  
Cognitive Changes ◽  
Central Nervous System Cancer ◽  
Pharmacologic Treatments

As the population of cancer survivors has grown into the millions, there is increasing emphasis on understanding how late effects of treatment impact survivors’ ability return to work/school, ability to function and live independently, and overall quality of life. Cognitive changes are one of the most feared problems among cancer survivors. This chapter describes the growing literature examining cognitive changes associated with non-central nervous system cancer and cancer treatment. Typical elements of cancer treatment are discussed, followed by a description of clinical presentation, self-reported and objectively assessed cognitive findings, and results of structural and functional neuroimaging research. Genetic and other risk factors for cognitive decline following treatment are identified and discussed, together with biomarkers and animal models of treatment-related effects. This is followed by a discussion of behavioral and pharmacologic treatments. Finally, challenges and recommendations for future research are provided to help guide subsequent research and theoretical models.

Cancer therapy-related cardiac dysfunction: is endothelial dysfunction at the heart of the matter?

2021 ◽  
Vol 135 (12) ◽  
pp. 1487-1503
Author(s):  
Crizza Ching ◽  
Dakota Gustafson ◽  
Paaladinesh Thavendiranathan ◽  
Jason E. Fish
Keyword(s):  
Cancer Therapy ◽  
Cardiac Dysfunction ◽  
Inflammatory Markers ◽  
Cancer Survival ◽  
Growth Factor Receptor ◽  
Cardiovascular Effects ◽  
Cardiovascular Complications ◽  
Cardiac Biomarkers ◽  
Cancer Therapies ◽  
The Impact

Abstract Significant improvements in cancer survival have brought to light unintended long-term adverse cardiovascular effects associated with cancer treatment. Although capable of manifesting a broad range of cardiovascular complications, cancer therapy-related cardiac dysfunction (CTRCD) remains particularly common among the mainstay anthracycline-based and human epidermal growth factor receptor-targeted therapies. Unfortunately, the early asymptomatic stages of CTRCD are difficult to detect by cardiac imaging alone, and the initiating mechanisms remain incompletely understood. More recently, circulating inflammatory markers, cardiac biomarkers, microRNAs, and extracellular vesicles (EVs) have been considered as early markers of cardiovascular injury. Concomitantly, the role of the endothelium in regulating cardiac function in the context of CTRCD is starting to be understood. In this review, we highlight the impact of breast cancer therapies on the cardiovascular system with a focus on the endothelium, and examine the status of circulating biomarkers, including inflammatory markers, cardiac biomarkers, microRNAs, and endothelial cell-derived EVs. Investigation of these emerging biomarkers may uncover mechanisms of injury, detect early stages of cardiovascular damage, and elucidate novel therapeutic approaches.

scholarly journals Cardiovascular Vulnerability to COVID-19 in Cancer Survivors

2020 ◽  
Author(s):  
Beshay Zordoky
Keyword(s):  
Cardiovascular Diseases ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Myocardial Damage ◽  
Cardiovascular Complications ◽  
World Health ◽  
Global Pandemic ◽  
Increased Risk ◽  
Health Organization ◽  
Shared Risk

Coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization on March 11, 2020. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2). Although primarily a respiratory disease, cardiovascular complications of COVID-19 have been increasingly recognized. In addition, higher fatality has been reported in COVID-19 patients with underlying cardiovascular diseases. Cancer survivors have a considerably increased risk for premature cardiovascular diseases, mainly due to cardiotoxic cancer treatments. Therefore, it is foreseeable that cancer survivors will be more vulnerable to cardiovascular complications caused by COVID-19. In this review, three scenarios for increased cardiovascular complications of COVID-19 in cancer patients are proposed. In the first scenario, cardiotoxic cancer treatment and COVID-19 synergize to exacerbate direct myocardial damage. In the second scenario, cardiotoxic cancer treatment leads to a reduced cardiac reserve in cancer survivors, making them more vulnerable to COVID-19 in a “two-hit” model. The third scenario suggests that several shared risk factors may aggravate cardiovascular complications caused by both cancer treatment and COVID-19. Taken together, cancer survivors may be more vulnerable to cardiovascular complications when challenged by the COVID-19, and special cardiovascular care should be given to these patients.

scholarly journals Biochemical and echocardiographic markers for the early detection of car detection of cardiotoxicity under monoclonal antibodies ther xicity under monoclonal antibodies therapy

2021 ◽  
Vol 8 (1) ◽  
pp. 34-43
Author(s):  
Ionela-Emilia Popovici ◽  
Angela Cozma ◽  
Olga Orasan ◽  
George Ciulei ◽  
Ana Poenar ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Cancer Therapy ◽  
Early Detection ◽  
Imaging Techniques ◽  
Strain Analysis ◽  
Cardiovascular Effects ◽  
Cardiac Monitoring ◽  
Future Research ◽  
Car Detection ◽  
Detection And Diagnosis

The progress made over the past years in the field of cancer therapy has led to a significant decrease in cancer mortality, but these therapies have many adverse effects, cardiovascular effects being among the most frequent ones. For increasing lifelong expectancy of surviving cancer patients, cardiac monitoring represents an important task. Current studies and practice recommend echocardiography using strain analysis for monitoring the cardio toxic effects of cancer therapy. The potential of combining imaging techniques with biomarkers for the early detection and diagnosis seems a promising path for future research.

Understanding and predicting fatigue, cardiovascular (CV) decline, and events after breast cancer treatment (UPBEAT): A prospective cardio-oncology study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. TPS11634-TPS11634
Author(s):  
Kerryn Reding ◽  
Ralph D'Agostino ◽  
Glenn Jay Lesser ◽  
Heidi D. Klepin ◽  
Lynne I. Wagner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Therapy ◽  
Cancer Treatment ◽  
Time Course ◽  
Early Stage ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Exercise Intolerance

TPS11634 Background: Modern treatment for breast cancer (BC) has led to improved survival; however, this improvement can be offset by an increase in cancer therapy-related morbidity and mortality. Over one-third of early stage BC patients treated with cancer therapy experience CV injury, left ventricular (LV) dysfunction, exercise intolerance, or fatigue. CV disease is a leading cause of mortality in BC survivors. There is limited information on the time course and long-term CV health of BC survivors. UPBEAT, a multicenter study, will prospectively evaluate CV risk factors and outcomes in early stage BC patients,treated with modern cancer therapies. This will facilitate evaluation of primary CV prevention strategies in this patient population. Methods: This is a prospective cohort study of 840 patients with early stage (I-III) BC treated with chemotherapy +/- radiation and 160 controls. Baseline and serial longitudinal measures will examine the influence of cancer treatment on CV function, exercise capacity and fatigue, and future development of CV events. The comprehensive assessment of factors includes ascertainment of cardiac biomarkers, CV risk factors, comorbidities, functional status (e.g., disability measures, Expanded SPPB), neurocognitive tests, behavioral risk factors, socio-demographics, and quality of life at baseline, 3-, 12-, and 24-mos. Outcomes measured at the same time points, include a deep phenotyping of CV dysfunction (via cardiac MRI assessing LV end diastolic volume, LV end systolic volume, LV ejection fraction, myocardial strain, strain rate, left atrial volumes and mass, and aortic stiffness), exercise intolerance (submaximal as 6-minute walk test and maximal as VO2peak via cardiopulmonary exercise test), fatigue (via FACT-F). Eligibility criteria are: age >18 years; ECOG 0-2, able to walk without symptoms; and for BC patients, treatment with chemotherapy. 143 participants are accrued and currently enrolling through ECOG and NCORP sites. Participants will be followed for 9 years with active surveillance of CV events, i.e., heart failure, myocardial infarction, stroke, all-cause and CV death. Clinical trial information: NCT02791581.

scholarly journals An overview and bibliometric analysis on the colorectal cancer therapy by magnetic functionalized nanoparticles for the responsive and targeted drug delivery

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Mahdieh Darroudi ◽  
Mehrdad Gholami ◽  
Majid Rezayi ◽  
Majid Khazaei
Keyword(s):  
Magnetic Field ◽  
Colorectal Cancer ◽  
Drug Delivery ◽  
Magnetic Nanoparticles ◽  
Cancer Therapy ◽  
Cancer Treatment ◽  
High Performance ◽  
Future Research ◽  
General View ◽  
Research Perspective

AbstractWith the growing demands for personalized medicine and medical devices, nanomedicine is a modern scientific field, and research continues to apply nanomaterials for therapeutic and damaged tissue diagnosis. In this regard, substantial progress has been made in synthesizing magnetic nanoparticles with desired sizes, chemical composition, morphologies, and surface chemistry. Among these materials, nanomagnetic iron oxides have demonstrated promise as unique drug delivery carriers due to cancer treatment. This carrier could lead to responsive properties to a specific trigger, including heat, pH, alternative magnetic field, or even enzymes, through functionalization and coating of magnetic nanoparticles, along with biocompatibility, good chemical stability, easy functionalization, simple processing, and ability to localize to the tumor site with the assistance of external magnetic field. Current studies have focused on magnetic nanoparticles’ utilities in cancer therapy, especially for colorectal cancer. Additionally, a bibliometric investigation was performed on the public trends in the field of the magnetic nanoparticle to drug delivery and anticancer, which represented progressing applications of these carriers in the multidisciplinary zones with a general view on future research and identified potential opportunities and challenges. Furthermore, we outline the current challenges and forthcoming research perspective for high performance and fostering advanced MNPs in colorectal cancer treatment. Graphical Abstract

Cardiovascular Complications of Cancer Therapy in Cancer Survivors

2021 ◽  
pp. 177-193
Author(s):  
Susan Dent ◽  
Ioannis Milioglou ◽  
Harsh Patolia ◽  
Brandy Patterson ◽  
Avirup Guha
Keyword(s):  
Cancer Therapy ◽  
Cancer Survivors ◽  
Cardiovascular Complications

scholarly journals Aerobic exercise in anthracycline-induced cardiotoxicity: a systematic review of current evidence and future directions

2017 ◽  
Vol 312 (2) ◽  
pp. H213-H222 ◽  
Author(s):  
Joseph J. Chen ◽  
Pei-Tzu Wu ◽  
Holly R. Middlekauff ◽  
Kim-Lien Nguyen
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Cancer Therapy ◽  
Cancer Survivors ◽  
Aerobic Exercise ◽  
Pediatric Population ◽  
Childhood Cancer Survivors ◽  
Cardiovascular Complications ◽  
Current Evidence ◽  
Cancer Therapies

Cancer and cardiovascular disease are major causes of morbidity and mortality worldwide. Older cancer patients often wrestle with underlying heart disease during cancer therapy, whereas childhood cancer survivors are living long enough to face long-term unintended cardiac consequences of cancer therapies, including anthracyclines. Although effective and widely used, particularly in the pediatric population, anthracycline-related side effects including dose-dependent association with cardiac dysfunction limit their usage. Currently, there is only one United States Food and Drug Administration-approved drug, dexrazoxane, available for the prevention and mitigation of cardiotoxicity related to anthracycline therapy. While aerobic exercise has been shown to reduce cardiovascular complications in multiple diseases, its role as a therapeutic approach to mitigate cardiovascular consequences of cancer therapy is in its infancy. This systematic review aims to summarize how aerobic exercise can help to alleviate unintended cardiotoxic side effects and identify gaps in need of further research. While published work supports the benefits of aerobic exercise, additional clinical investigations are warranted to determine the effects of different exercise modalities, timing, and duration to identify optimal aerobic training regimens for reducing cardiovascular complications, particularly late cardiac effects, in cancer survivors exposed to anthracyclines.

Understanding and predicting fatigue, cardiovascular (CV) decline & events after breast cancer treatment (UPBEAT): A prospective multi-center wake forest NCORP research-base study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS602-TPS602
Author(s):  
Susan Faye Dent ◽  
Kerryn Reding ◽  
Glenn Jay Lesser ◽  
Heidi D. Klepin ◽  
Lynne I. Wagner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Therapy ◽  
Cancer Treatment ◽  
Time Course ◽  
Early Stage ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Exercise Intolerance

TPS602 Background: Modern treatment for breast cancer (BC) has led to improved survival; however, this improvement can be offset by an increase in cancer therapy-related morbidity and mortality. Over one-third of early stage BC patients treated with cancer therapy experience CV injury, left ventricular (LV) dysfunction, exercise intolerance, or fatigue. CV disease is a leading cause of mortality in BC survivors. There is limited information on the time course and long-term CV health of BC survivors. UPBEAT, a multicenter study, will prospectively evaluate CV risk factors and outcomes in early stage BC patients, treated with modern anticancer therapies. This will facilitate evaluation of primary CV prevention strategies in this patient population. Methods: This is a prospective cohort study of 840 patients with early stage (I-III) BC treated with chemotherapy +/- radiation and 160 controls. Baseline and serial longitudinal measures will examine the influence of cancer treatment on CV function, exercise capacity and fatigue, and the future development of CV events. The comprehensive assessment includes: ascertainment of cardiac biomarkers, CV risk factors, comorbidities, functional status (e.g., disability measures, expanded short physical performance battery), neurocognitive tests, behavioral risk factors, socio-demographics, and quality of life at baseline, 3-, 12-, and 24-mos. Outcomes measured at the same time points include a deep phenotyping of CV dysfunction (via cardiac MRI assessing LV end diastolic volume, LV end systolic volume, LV ejection fraction, myocardial strain, strain rate, left atrial volumes and mass, and aortic stiffness), exercise intolerance (submaximal as 6-minute walk test and maximal as VO2 peak via cardiopulmonary exercise test), and fatigue (via FACT-F). Eligibility criteria: age > 18 years; ECOG 0-2, able to walk without symptoms; receiving chemotherapy +/- HER2 targeted agent(s). To date, 244 participants are enrolled through 12 NCORP or ECOG-ACRIN sites. An additional 7 sites are onboarding and will be enrolling later in the year. Participants will be followed for 9 years with active surveillance of CV events (i.e., heart failure, myocardial infarction, stroke, all-cause and CV death). EA NCORP Grant: 2 UG1 CA189828 06; Research Base Grant: 2UG1 CA189824; R01: 1R01CA199167. Clinical trial information: NCT02791581 .

Feasibility of fully remote administration of problem-solving skills training (PSST) to adult cancer survivors in community settings.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1536-1536
Author(s):  
Katia Noyes ◽  
Alaina Zapf ◽  
Rachel Depner ◽  
Tessa Flores ◽  
Alissa Huston ◽  
...  
Keyword(s):  
Problem Solving ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
White Women ◽  
Local Population ◽  
Skills Training ◽  
Future Research ◽  
Community Settings ◽  
Problem Solving Skills ◽  
Adult Cancer Survivors

1536 Background: Cancer survivors experience significant stress throughout cancer treatment and especially during transition back to normal life. These stressors are particularly severe for rural or socially disadvantaged patients with limited access to care. Improving their problem-solving skills is known to help patients make reasoned and timely decisions about survivorship care that reduce stress and enhance quality of life, physical and social functioning, and overall cancer prognosis. This pilot implementation study examined barriers to and facilitators of providing Problem-Solving Skills Training (PSST) to adult cancer survivors and their caregivers in community settings. Methods: Patients (n = 50) who completed their definitive cancer treatment and cancer survivorship visit within the previous 6 months were recruited from two regional cancer centers and affiliated community cancer clinics. Patients with NCCN distress level >2 were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions using the Bright IDEAS system of teaching problem solving. Training was offered by a trained therapist in person at the patient’s preferred location or remotely. Patients were invited but not required to include a supportive other (SO). Patient outcomes were assessed at baseline (T1), the end of the intervention/3 months (T2), and 3 months post intervention/6 months (T3). We examined patient and caregiver preferences for mode of communication and therapy, barriers to PSST participation, and adherence rates. An independent consultant interviewed patients and caregivers about factors that promote or inhibit intervention sustainability and its wider adaptation and usefulness. Results: Average age of the participants was 63 years (45-87) with gender, racial and ethnic distributions representative of the local population (64% women, 88% white). Women were 80% less likely to include a SO than men. Among the third of the patients recruited fully remotely, 50% preferred receiving consent materials via regular mail and 18% preferred electronic communication. Among the two patients lost to follow-up before PSST completion and one patient who withdrew despite reporting significant distress, none had a SO in the study. Seventy-six percent of the PSST patients completed the training (defined as > 6 sessions). After study completion, all patients and caregivers reported high satisfaction with Bright IDEAS and high probability of continuing to use the skills learned. Conclusions: Despite significant distress and numerous reported social challenges, patients and caregivers in the PSST arm demonstrated high adherence, skill retention and overall satisfaction. Future research should be tailored to accommodate the preferred type of communication and recruitment approaches of the targeted population and emphasize the positive role of informal caregivers. Clinical trial information: NCT03567850.

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