Page 21 - Today's Dietitian (February 2020)

Cancer & Cardiovascular Care

An Overview of This Emerging Practice Area

By Karen Collins, MS, RDN, CDN, FAND Cancer Treatment and CVD Risk
C considered separate medical fields, Increased risk of CVD in cancer survivors can reflect 2

ardiology and oncology often are
yet they frequently intertwine.
combined effects of several factors. These include
common age-related changes, direct consequences of
Cardiovascular health before a cancer
cancer treatment, and indirect results of cancer and its
diagnosis and cardiovascular effects of
cancer treatments both influence health
treatment (including cardio-respiratory deconditioning
and weight gain), acting across multiple body systems.
outcomes in cancer survivors.
This article explores the growing
field of cardio-oncology and potential
although late effects may go unseen until months or
decades after treatment.
opportunities for dietitians to play a
valuable role. Although cardiovascular Some side effects can occur during cancer treatment,
Efforts to address cardiovascular risk related to
risk factors increase in many cancer survivors, cancer therapy often have focused on the early detection
discussion of modifying these risk factors during and and prevention of congestive heart failure. Yet cancer
after cancer treatment, especially through lifestyle, may treatments can cause a variety of cardiovascular tox-
not be addressed as recommended. Statements from icities, including cardiac arrhythmias, hypertension,
cardiovascular and oncology professional organizations thromboembolism, valvular disease, accelerated ath-
now emphasize the need to promote heart-healthy erosclerosis and ischemic heart disease, and peripheral
lifestyles for cancer survivors. 1,2 vascular disease and stroke. 2,5-7
To prevent or minimize these effects, work is in
Growth of Cardio-Oncology progress to identify ways to adjust treatment choice,
Currently, more than 16.9 million people in the United dose, and timing, or provide additional cardio-
States have a history of cancer. The number of US cancer protective treatments. Risk identified in cohort studies
survivors is predicted to increase further—to more than often reflects older protocols and doesn’t account for
22.1 million by 2030—based only on the growth and advances in methods to reduce cardiotoxicity. Still,
3
aging of the population. although these side effects occur in a minority of
Almost two-thirds of cancer survivors are aged 65 patients, the health impact is significant when they
3
or older. And people living at least five years beyond a do. And survivors with past exposures to cardiotoxic
cancer diagnosis have significant increases in CVD risk therapies should continue to be considered at
factors and a 1.3- to 3.6-fold greater risk of death from increased risk for developing cardiac dysfunction.
1
CVD compared with age-matched counterparts with no Heart failure is a progressive disorder that can
history of cancer. CVD may become even more preva- develop during or after cancer treatment. During treat-
2
lent among oncology patients; the population of aging ment, it can cause interruption or discontinuation
adults is growing, and continued improvements in suc- of cancer-directed therapy, potentially reducing the
cess of cancer treatment bring potential for late effects chance for long-term survival. It may result as a side
1,3
that can emerge months or even years after comple- effect of anthracycline chemotherapy (eg, doxorubi-
tion of cancer treatment. As a result, cardio-oncology cin), HER2-targeted therapy, or radiation therapy with
2,3
(sometimes called onco-cardiology) programs are grow- the heart in the field of treatment. These treatments
6,7
ing, dedicated to the prevention and treatment of CVD commonly are used for breast cancer and certain leuke-
in patients with cancer. 4 mias and lymphomas, including those that are among
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