In the last two decades, there has been significant advances in the area of cancer therapy with an important improvement in both quality of life and overall survival. In fact, there is now a paradigm shift in relation to the cancer patient, who has come to be seen as having chronic illness.
However, these benefits were accompanied by an increase in the rate of adverse effects of therapy on various organs, particularly in the cardiovascular system. In fact, the incidence of cardiotoxicity has been continuously more evident and may compromise the efficacy of the various cancer therapies currently available. On the other hand, given the aging of the population, these therapies are also being administered to older patients with pre-existing cardiovascular diseases.
The mechanism of toxicity of oncological drugs is diverse, and potentially all drugs used may have cardiotoxic effects. The effects of anthracyclines that have irreversible cardiotoxicity, progressive heart failure and negative prognostic implications, but also monoclonal antibodies such as trastuzumab, which induce cellular dysfunction, can also cause apparently reversible cardiac failure with the drug discontinuation and, more recently, cases of myocarditis induced by immune modulators. At the vascular level, angiogenesis inhibitors that may induce arterial hypertension and drugs with a direct endothelial toxic effect, such as cisplatin and bevacizumab, which may cause arterial and venous cardio-embolic events, are examples.
Radiation therapy alone or in combination with chemotherapy may affect various cardiac structures, including the pericardium, valves, coronary arteries as well as the conduction system. These manifestations are usually later and may occur more than 10 years after therapy.
There is no known risk for cardiotoxicity throughout life, nor is individual susceptibility to the onset of cardiotoxicity. These and other aspects are undergoing intense clinical and translational research worldwide.
Given the size and relevance of this issue, it makes perfect sense to speak of Cardio-Oncology as a new medical subspecialty. The growing number of cancer patients with heart problems imply a very specific approach that should be shared between cardiologists and oncologists. Everywhere now, are emerging small units of cardio-oncology, depending on the size of the hospitals. In 2009 the International Society of Cardiology (ICOS) was established with one pole in Europe and another in the United States of America. Its main objective is to promote the prevention, diagnosis and appropriate treatment of cardiovascular diseases in this group of patients, allowing them to be in an ideal condition for oncological treatment. It will also be important to implement practical recommendations and guidelines for monitoring the heart before, during and after these therapies, such as those already published in the Journal of the American Society of Echocardiography in 2014 and in the European Heart Journal in 2016. More recently, the European Society of Cardiology founded the Council of Cardio-Oncology and the Journal of the American College of Cardiology (JACC) announced the publication of the JACC Cardio-Oncology for 2019.
Finally, it is of primary importance to stimulate clinical and translational research in Cardio-Oncology.
No final do curso, os participantes deverão estar aptos para:
O Curso decorre nos dias 24 e 25 JAN'19, das 9h às 18h.
Este curso tem avaliação de aprendizagem e é creditado em 1 ECTS.
As sessões decorrerão em regime de aulas teóricas com painéis de discussão temática com uma ou mais apresentações por peritos no tópico em análise, seguidas de debate e aprofundamento das diferentes perspetivas apresentadas, tendo como suporte materiais previamente distribuídos.
Médicos Cardiologistas, Oncologistas, Radioterapeutas, Internistas, Clínicos Gerais, Investigadores, Enfermeiros, Técnicos de Diagnóstico e Terapêutica.
Auditório 58 - Piso 01
Faculdade de Medicina de Lisboa- Edifício EGAS MONIZ
Cardio-Oncology Services: rationale, organization, and implementation
Drug-Drug Interactions of Common Cardiac Medications and Chemotherapeutic Agents
Long term survivors
Sobreviventes mama guidelines
Lost in transition
A cardio-oncology program should have three main components: (1) cardio-oncology clinic; (2) training; and (3) research.
The clinic's protocols for monitoring cardiotoxicity should include three steps: assessment before beginning cancer therapy, particularly in patients with cardiovascular risk factors; assessment during treatment, in order to detect and treat cardiovascular complications promptly; and monitoring after treatment. The use of a risk score enables better identification of patients who should be referred for cardio-oncology consultation.
Appropriate algorithms that are easy to apply in clinical practice are needed in order to enable prompt detection and monitoring of cardiotoxicity.
As cardio-oncology is a new frontier in medicine, it should also include a training component, both undergraduate and postgraduate, as recommended by the ESC. It is important that there should be a period of training in cardio-oncology for both oncologists and cardiologists, at a basic or advanced level according to individual options.
Clinical and translational research projects should be organized aimed at early identification of cardiotoxicity and of individual susceptibility to developing adverse cardiac effects. Cardiotoxicity is an increasing concern in clinical and preclinical trials of new drugs. Adverse cardiac effects often result in discontinuation of cancer therapy. There is therefore a growing need for better prediction of the risk of cardiotoxicity of new drugs at an early stage in their investigation.
Diretor do Departamento do Coração e Vasos do CHULN
Coordenadora da Consulta Externa de Cardiologia do CHULN
Responsável da Consulta de Cardio-Oncologia do CHULN