Heart disease and cancer are the two leading causes of death in the developed world. Public health campaigns targeting these conditions have led to significant improvement in population awareness and prevention of disease, however, there remains an inadequate acknowledgement of their coexistence. Due to advancements in modern cancer therapy, we are seeing higher rates of cure and the conversion of a terminal illness into a chronic disease. As a result, cardiovascular disease now competes with cancer as the leading cause of death in survivors of certain tumour streams. Attention to reducing the risk of cardiovascular disease should thus be a priority in the long-term management of oncology patients.
According to the International Cardio-Oncology Society, the guiding principle of cardio-oncology is the integration of clinical disciplines and integral to this is the knowledge of cardiology, oncology, and hematology management. Assessing, understanding, and mitigating the risk of cancer therapy related cardiac disease (CTRCD) is crucial to the safe and effective management of patients with cancer. This must be balanced against the absolute benefit of the cancer treatment and is a dynamic variable that changes throughout the treatment pathway. The principles underlying this are threefold: Firstly, antecedent CVD can influence the cancer treatment selection and tolerability. It has been well established that traditional cardiovascular risk factors (CVRF) contribute to both total mortality and breast cancer specific mortality and the identification and management of CVRF in cancer patients is a class one recommendation. Secondly, anti-cancer therapy can cause cardiotoxicity that can impact ongoing treatment. The strict management of CVRF coupled with the early identification and treatment of sub-clinical cardiotoxicity offers the best chance of preventing or ameliorating overt CTRCD. Finally, latent cardiotoxicity can negatively impact cancer survivorship. Complicating this are rapidly evolving therapeutics with diverse effects and a limited understanding of long-term cardiovascular impact.