Dr Crystal S. Denlinger Discusses Potential Cardiotoxicity Concerns for Cancer Survivors

Historically cancer survivorship programs have not emphasized cardiac follow-up and there is not a lot of long-term data on cardiac toxicity in patients who received certain drugs, but that is changing as patients live longer and fuller lives after treatment, explained Crystal S. Denlinger, MD, from the Fox Chase Cancer Center in Philadelphia.

Transcript (slightly modified)

Do survivorship programs appropriately emphasize cardiac follow-up for cancer patients?

Historically speaking: not really. And that's in large part because we don't have a lot of long-term data on cardiac toxicity in patients that receive anthracycline or other cardiotoxic drugs. The exception is the HER2+ patients who receive trastuzumab or HER2-directed therapy in the neo-adjuvant or adjuvant setting. In those patients they typically do receive some kind of cardiac follow-up during the course of their HER2-type therapy and at least one post-treatment cardiac assessment. But for most patients who receive non-HER2-directed therapy, like those patients who were just treated with anthracyclines, we may be clinically evaluating those patients as part of our routine clinical evaluation, but it's not necessarily a cardiac-specific evaluation.

I think that is changing as we recognize that there are patients who are at higher risk of cardiovascular complications of therapy. As we get newer and different drugs that have different cardiovascular toxicities and in fact I think that may be evolving as we think more about cardiovascular reserve, cardiovascular toxicities, and what those long-term implications are because we're seeing patients live longer and live more fuller lives after their treatment.

So I think survivorship programs are starting to recognize that and it's part of why the National Comprehensive Cancer Network Survivorship Guideline chose to include the anthracycline-induced cardiotoxicity algorithm in this particular addition of the guideline. Because it is an important and potentially life-altering complication of cancer therapy. And we need to be able to figure out: who is at risk, how do we assess this patients, and is there something we can do to change their long-term outcome?

Right now at this stage of data, we don't have a lot of large randomized trials that state definitive evidence that routine surveillance or early institution of heart failure therapies changes outcomes and I think more research is really needed to be able to show this is important. But what we do know from the heart failure literature in non-cancer patients is that treating asymptomatic patients with structural heart disease or patients who are at risk of heart failure with angiotensin-converting-enzyme inhibitors can improve heart failure-associated outcomes like the development or hospitalization of congestive heart failure or death from congestive heart failure.

And I think those outcomes and those therapies can be translated into the survivor population. But I think more data is needed before we can definitively say that's the case.