The reason I’m here is to talk about the cardiovascular effects of cancer treatment which is an emerging important field. As the oncologists have got better at curing cancer, keeping people alive for longer and turned cancer into a long-term condition rather than a rapidly fatal disease, we’ve got much more evidence and effect of the long-term toxicities on the cardiovascular system and there are a whole variety of different aspects of this, from the traditional anthracycline damage to cardiomyocytes to electrical damage to endothelial damage. It’s really working out how best to manage that, how best to allow the oncologists to deliver their treatment without causing long-term cardiovascular side effects.
How is cardiovascular disease linked to cancer?
They have very similar risk factors for developing cardiovascular disease and cancer, of course. It’s one of the themes is trying to minimise those risk factors to improve prognosis of the population, not just people with cancer. But it’s really important, in the old days people with cancer were regarded as having such a short-term prognosis that there was no advantage to them in managing their overall cardiovascular risk but that’s clearly not the case. A large number of the patients who have cancer in fact go on to die of cardiovascular disease rather than the current cancer, it’s the second commonest cause of mortality.
How have the successes of cancer treatment led to new issues?
To put it into context, the ten year survival of cancer has doubled from the 1970s to the current decade. So it’s a huge demographic change resulting in a huge increase in the number of people surviving with cancer in the long run. That’s a problem of success, if you like, that having kept people alive, having stopped them dying of cancer we now need to manage their other risk factors so that they survive with a good quality of life for as long as possible.
How can oncologists and cardiologists be respectively better informed?
The understanding by oncologists and cardiologists is much better than it was ten years ago but it’s clearly nowhere near as good as it needs to be. That’s partly because of a lack of good quality data; the oncology trials have never been powered to pick up cardiovascular side effects so we’re extrapolating. But what we are now developing are cardiovascular intervention trials where we can see what works, what can prevent people developing toxicity, what can treat it most effectively.
What would you advise as the next step forward for people in this field?
The next step forwards is a greater understanding of the long-term effects of cancer treatment on the heart and to try and allow the best cancer treatment possible to be given to the patients but also to minimise their long-term cardiovascular risks. The way to do that is to look at overall risk and manage it as we would with anybody else but have a better understanding of the specific toxicities associated with particular cancer treatments and manage those at the time in a proactive way so as to minimise the long-term effects.
Is there a reason why we see this particularly with geriatrics?
With particular relevance to the geriatric population we know that they have a higher risk of having cardiotoxicity than younger people, partly because as we go through life we have fewer cardiomyocytes, it’s quite normal to lose them with aging so your reserve is less as you get older. Then you have the other cardiovascular risk factors which tend to increase during life, so you are more susceptible. As those patients are living longer they are living long enough, if you like, to see those toxicities but, as I have said a couple of times, it’s really important that we don’t prevent people from getting the right cancer treatment just because people are concerned about cardiovascular effects. We just manage it appropriately.