Il Cardiologo Generale (CG) è coinvolto nella gestione del paziente oncologico con possibili complicanze cardiovascolari (CV) sia per motivi epidemiologici, che per la correzione dei fattori di ...rischio comuni alle malattie CV e al cancro, che per l’individuazione e la cura di effetti tossici della terapia oncologica, soprattutto nel Follow-Up (F-U) a lungo termine. Per un’ottimale gestione del paziente Cardio-Oncologico (C-O) è necessaria una profonda azione di insegnamento ed educazione all’argomento ed una pianificazione rigorosa dell’organizzazione dei servizi di C-O che prevedano anche l’inclusione del CG.
This book is designed for clinical cardiologists and other physicians working with cardiac patients, where specific specialized teams of cardio-oncologists are not available and who are called to ...perform a clinical consultation to evaluate both the cardiac condition and the eligibility for chemotherapy or radiotherapy treatment, and to evaluate if a cancer treatment produces toxic effects on a patient treated with chemo or radiotherapy and if appearance of new symptoms is due to this treatment. In recent years, progress in oncologic therapy has resulted in important developments and the prognostic improvement of patients with malignancy. The cornerstone of chemotherapy are the anthracyclines (and the analogue Mitoxantrone), that are direct cellular toxic agents and that are among the most powerful anti-neoplastic drugs, but their cardiac toxicity is well known. Significant breakthroughs in cancer therapy have also been achieved with the introduction of signalling inhibitors, such as VEGF inhibitors, HERB2 inhibitors or TK inhibitors used alone or in combination with direct cellular toxic drugs. However, these signalling inhibitors may interact also with cardiovascular signalling and therefore may have functional or structural effects on the myocardium. This can be permanent or reversible, with impairment of the global conditions and important side effects, and increase both morbidity and mortality and worsening of quality of life. Chemotherapy and radiotherapy can have acute detrimental effects that can be present for years after treatment and that can lead to cardiac consequences also after long periods of no clinic sequelae. Patient numbers with cancer problems will dramatically increase in the next years and thus every cardiologist will need to have the correct information and the skills to manage these situations in the correct way. This book will provide these tools for them.
Il ruolo dell’attività fisica nella prevenzione primaria delle neoplasie è noto; negli ultimi anni l’esercizio svolto con sistematicità ha acquisito un ruolo anche in prevenzione secondaria, ...riducendo il rischio di recidiva di cancro e migliorando la prognosi e la qualità di vita dei pazienti. L’esercizio fisico è altresì raccomandato per prevenire e contrastare la cardiotossicità dei trattamenti neoadiuvanti e adiuvanti, e per limitare gli effetti invalidanti di fatigue, sarcopenia e cachessia. Dalla letteratura internazionale e dalle esperienze di pratica clinica emerge sempre più l’importanza di introdurre programmi di esercizioterapia nella gestione globale del paziente oncologico, con una prescrizione sartoriale concordata a livello multidisciplinare (oncologo, cardiologo, fisiatra, fisioterapista), che tenga conto della storia naturale del tipo di cancro, del rischio di complicanze, degli effetti terapeutici e collaterali delle terapie in corso, oltre a valutare problemi di sicurezza ed eventuali controindicazioni.
Aims: Anticancer therapies have extended the lives of millions of patients with malignancies, but for some this benefit is tempered by adverse cardiovascular (CV) effects. Cardiotoxicity may occur ...early or late after treatment initiation or termination. The extent of this cardiotoxicity is variable, depending on the type of drug used, combination with other drugs, mediastinal radiotherapy, the presence of CV risk factors, and comorbidities. A recent position paper from the European Society of Cardiology addressed the management of CV monitoring and management of patients treated for cancer. Methods and results: The current document is focused on the basis of the Cardio-Oncology (C-O) Services, presenting their rationale, organization, and implementation. C-O Services address the spectrum of prevention, detection, monitoring, and treatment of cancer patients at risk of cardiotoxicity and/or with concomitant CV diseases. These services require a multidisciplinary approach, with the aims of promoting CV health and facilitating the most effective cancer therapy. Conclusion: The expected growing volume of patients with cancer at risk of developing/worsening CV disease, the advent of new technological opportunities to refine diagnosis, and the necessity of early recognition of cancer therapy-related toxicity mandate an integrative multidisciplinary approach and care in a specialized environment. This document from the ESC Cardio-Oncology council proposes the grounds for creating C-O Services in Europe based on expert opinion.
PDF
