CARDIO-ONCOLOGY

ABOUT CARDIO-ONCOLOGY

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.

Curso 2019

24th and 25th January, 2019

Learning objectives

At the end of the course, participants should be able to:

  • Define cardiotoxicity and its relevance in the treatment of cancer.
  • To know the mechanism of action of the most frequent oncological therapies and to perceive its early and late cardiotoxicity.
  • Identify the major cardiovascular problems with new therapies and the best strategies to monitor cancer therapy and to detect and treat cardiotoxicity.
  • Recognize the most appropriate imaging technologies to detect cardiotoxicity (Echocardiography, RNA, MRI, AngioTC) and how to use them in clinical practice.
  • Analyze the guidelines and how to use them in clinical practice.
  • Define the best diagnostic and therapeutic strategies for heart failure, arrhythmias, hypertension, thromboembolism, cardiopathy? the ischemic and valvular.
  • Analyze long-term survival and how to monitor patients receiving high-risk therapy such as anthracyclines and thoracic radiotherapy.
  • Hands-On. Strain Imaging Training.

Duration / ECTS

The Course will take place on the 24th and 25th JAN'19, from 9am to 6pm.
This course has a learning assessment and is credited to 1 ECTS.

Methodology

The sessions will be conducted in theoretical classes with thematic discussion panels with one or more presentations by experts on the topic under analysis, followed by a discussion and deepening of the different perspectives presented, supported by previously distributed materials.

Recipients

Cardiologists, Oncologists, Radiotherapists, Internists, General Practitioners, Researchers, Nurses, Diagnostic and Therapeutic Technicians.

Local

Auditorium 58 - Floor 01
Faculty of Medicine of Lisbon- EGAS MONIZ Building

Investigation

Articles, publications and useful links

Cardio-oncology program

  • A cardio-oncology program should have three main components: (1) cardio-oncology clinic; (2) training; and (3) research.

    Cardio-oncology clinic Objectives
    • to provide specialized cardiological care to patients with cancer and a history of cardiovascular disease or who develop cardiac complications during cancer therapy;
    • to optimize cardiac care in cancer patients undergoing potentially cardiotoxic therapy;
    • to improve knowledge of cardiac complications of cancer treatments;
    • to promote early detection of cardiotoxicity (using clinical, laboratory and imaging biomarkers, of which echocardiography is the most important) and to establish intervention strategies to optimize cardiological care;
    • to improve patients' prognosis through a multidisciplinary and integrated approach involving different health professionals (physicians, nurses and technicians).

    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.

    Training

    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.

    Research

    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.

    CARDIO-ONCOLOGY TEAM

    Manuel Fiuza

    Prof.ª Doutora Manuela Fiuza

    Andreia Magalhães

    Doutora Andreia Magalhães

    Miguel Menezes

    Doutor Miguel N. Menezes

    Paula Costa

    CPL Paula Costa

Cardio-oncology Courses

Head Courses

Prof. Doutor Fausto J. Pinto

Dean, Faculty of Medicine - University of Lisbon

Head, Cardiology Dpt, Heart and Vascular Department, University Hospital, CHLN

Professor of Cardiology at Lisbon University School of Medicine

Prof.ª Doutora Manuela Fiúza

Professor of Cardiology at Lisbon University School of Medicine

Coordinator of Cardiac Outpatient Clinic

Responsible of Cardio-Oncology Consultation

Call us

For more information.

Cardiology service

Secretary

T: 217 805 356

Unidade de Formação Contínua

Secretary
Faculdade de Medicina da ULisboa

T: 217 985 100

continua@medicina.ulisboa.pt

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