Cardio-oncology (C-O) is a new sub-speciality that is rapidly expanding since the ESC Position Paper on Cancer Treatments and Cardiovascular Toxicity was issued in 2016. The main goal of C-O is to reduce the burden of cardiovascular (CV) complications related to cancer therapy and to assist in the overall care of patients from cancer diagnosis into survivorship.
Approximately 1 million patients are estimated to live after a cancer diagnosis in Ukraine. The number of new cases of cancer is 160 000 per year.
In Ukraine C-O started when a C-O Unit was formed at the Clinical Pharmacology Department of National Scientific Center “M.D.Strazhesko Institute of Cardiology” in 2016. It was initially established through the outpatients consulting, then progressed with in-patient treatment and has now grown significantly over the past 2 years. Now the C-O unit is transformed into a center and intends to coordinate the service across the country. It is unique due to being the first in Ukraine and rendering much more assistance to cancer patients with diagnostic and treatment support (emergency care, cardiovascular imaging, implanting devices, and catheterization lab) as the main cardiology clinic.
The experience of C-O setting was acquired from the well-known European clinics with advanced C-O service (Switzerland, Italy and Spain).
During recent years, the novel cancer treatment options are rapidly being developed. However, cardiologists face the problem of a growing number of CV complications in patients that received cancer therapy, that has negative impact on their survival. HF with LVEF decline along with the atrial fibrillation and arterial hypertension has risen with the development of targeted and immuno-therapies.
An urgent need exists for oncologists, cardiologists, and other specialists to be more proactive in developing strategies and collaboration in order to provide effective management of the patients affected by both cardiovascular disease and cancer.
The incidence of breast cancer is established to be in the first place in Ukraine (15 thousand cases per year), 25% among women of reproductive age. The need for strict monitoring of CV risks and cardiotoxicity is indisputable in this group of patients due to use of anthracyclines and targeted therapy in combination with radiation and surgery.
According to the National Cancer Registry data, Hodgkin and non-Hodgkin lymphomas incidence is approximately 3000 cases per year. Patients with lymphomas treated predominantly with anthracycline content chemotherapy in combination with radiation are vulnerable in cardiotoxicity. In several years these patients may form a cohort of cancer survivors with possible late CV complications of cancer therapy (ischemic heart disease, valve lesions, HF etc.), but long-term monitoring of heart function cannot be performed due to lack of appropriate standards of follow-up.
The unsolved issues mentioned above have led cardiologists of the C-O center and oncologists of Ukrainian National Cancer Institute to offer and initiate the programs for better prevention, diagnosis, management and long-term monitoring of breast cancer patients and patients with hematological malignances.
C-O educational learning has been provided to oncologists and chemotherapists in different cancer centers in order to be more effective in our goals through the solid awareness of C-O consulting terms, aims and results: "the earlier – the better".
The members of C-O team have joined educational sessions and participated in different conferences in the field of oncology that has led to successful feedback in increased number of patients to be examined before and in process of cancer treatment.
C-O unit members participate in ESC-COT (Cardiac-Oncology Toxicity) EACVI/HFA Pilot registry of breast cancer patients.
In 2018 the first Cardio-oncology session was organized with multidisciplinary participation of cardiologists, oncologists, general practitioners during National Ukrainian Congress of Cardiology.
Based on initiatives of C-O center members and Ukrainian Society of Cardiology a specific working group was approved and established in 2018.
The protocols for management of CV complications in cancer patients have been edited in collaboration with experts of the Ukrainian National Cancer Institute and implemented in clinical practice.
This year the National registry of cancer patients who undergo cardiotoxic cancer therapy is planned to be formed in collaboration with oncologists and is aimed to evaluate the relationship between cancer treatment and CV diseases. Members of C-O team have also initiated cooperation with patient's organizations by presenting information about life-style and physical activity during and after cancer therapy.
Several factors that limit the C-O development in Ukraine include the lack of financial assistance, different levels of medical infrastructure in local cancer centers; the use of biomarkers is not widespread; prophylactic treatment with ACE inhibitors and beta-blockers remains low, dexrazoxane is not registered yet in our country.
The implementation of the survey among oncologists, chemotherapists and general practitioners is the next step to be taken so as to clarify the importance of the C-O program in Ukraine.
As a conclusion, government support and future research are needed to promote our C-O program for improving the strategies in cancer patient’s management.
Authors
Sergey Kozhukhov, MD, PhD
Head of Cardio-oncology center
NSC “M.D. Strazhesko Institute of Cardiology”
Kyiv, Ukraine
Leader of Cardio-oncology Working Group
of Ukrainian Society of Cardiology
Nataliia Dovganych, MD, PhD
Coordinator of Cardio-oncology center
NSC “M.D. Strazhesko Institute of Cardiology”
Kyiv, Ukraine
Member of Cardio-oncology Working Group
of Ukrainian Society of Cardiology
Our mission: To reduce the burden of cardiovascular disease.