Key result
Patients already receiving oncological treatments at their first cardio-oncology visit had a higher incidence of cardiovascular events (46.2%) compared to treatment-naïve patients (12.3%).
Why the study?
As an aging population makes the coexistence of cancer and cardiovascular comorbidities more common, the impact of specialized cardio-oncology units and the challenges of managing cardiovascular complications require characterization.
Does the timing of referral to a Cardio-Oncology unit impact the incidence of cardiovascular events and survival in cancer patients?
Cohort (n=231)
No
Does the timing of referral to a Cardio-Oncology unit impact the incidence of cardiovascular events and survival in cancer patients?
Absolute Event Rate: 46.2% vs 12.3%
Baseline cardiovascular evaluation prior to starting oncological protocols is crucial to identify high-risk patients and mitigate the development of cardiac complications from antineoplastic treatments.
May support intensified monitoring during active cancer therapy; hypothesis-generating for optimal cardio-oncology referral timing.
AIMS: As the world population grows older, the co-existence of cancer and cardiovascular comorbidities becomes more common, complicating management of these patients. Here, we describe the impact of a large Cardio-Oncology unit in Southern Italy, characterizing different types of patients and discussing challenges in therapeutic management of cardiovascular complications. METHODS AND RESULTS: We enrolled 231 consecutive patients referred to our Cardio-Oncology unit from January 2015 to February 2020. Three different types were identified, according to their chemotherapeutic statuses at first visit. Type 1 included patients naïve for oncological treatments, Type 2 patients already being treated with oncological treatments, and Type 3 patients who had already completed cancer treatments. Type 2 patients presented the highest incidence of cardiovascular events (46.2% vs. 12.3% in Type 1 and 17.9% in Type 3) and withdrawals from oncological treatments (5.1% vs. none in Type 1) during the observation period. Type 2 patients presented significantly worse 48 month-survival (32.1% vs. 16.7% in Type 1 and 17.9% in Type 3), and this was more evident when in the three groups we focused on patients with uncontrolled cardiovascular risk factors or overt cardiovascular disease at the first cardiologic assessment. Nevertheless, these patients showed the greatest benefit from our cardiovascular assessments, as witnessed by a small, but significant improvement in ejection fraction during follow-up (Type 2b: from 50 [20; 67] to 55 [35; 65]; P = 0.04). CONCLUSIONS: Patients who start oncological protocols without an accurate baseline cardiovascular evaluation are at major risk of developing cardiac complications due to antineoplastic treatments.
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Cuomo et al. (2022) conducted a cohort in Cancer with cardiovascular comorbidities (n=231). Ongoing oncological treatment at first cardio-oncology visit (Type 2) vs. Treatment-naïve (Type 1) or completed treatment (Type 3) was evaluated on Cardiovascular events. Patients already receiving oncological treatments at their first cardio-oncology visit had a higher incidence of cardiovascular events (46.2%) compared to treatment-naïve patients (12.3%).
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