Cardiovascular issues

Abstract

Modern therapies for cancer are allowing increasing numbers of patients to enjoy long-term remission or cure of their disease. Unfortunately, the very modalities that help achieve these results cause injury to tissues or organs; these injuries may not be transient and may persist for the duration of survivorship. The heart, as a post-mitotic organ, does not regenerate after injury, and therefore is especially vulnerable to the long-term effects of a variety of treatment strategies for cancer. Although the future holds promise that new initiatives will allow organ or tissue regeneration, at present we must maximize protection of the heart at the time of exposure and minimize sequential stresses that might add to the cardiac burden during the period following the toxic injury. We now understand that cardiac injury may follow some forms of chemotherapy and biologic therapy as well as radiation therapy, and oncologists have learned to protect the heart to minimize the immediate damage. The burden of managing residual cardiac injury, however, migrates to the physician who provides care to cancer survivors, so that the late effects of treatment may be minimized. This chapter explores some of the strategies intended to improve quality of life for patients whose initial treatment for cancer resulted in cardiac injury.