The Role of Cardio-Oncology

With the number of cancer survivors in the United States expected to surpass 20 million by 2030, the detection and management of cardiovascular disease becomes increasingly important. Fadol discussed how cardiovascular disease has a significant impact on both treatment and quality of life for patients with cancer. As a comorbid condition, cardiovascular disease affects the choice of cancer therapy, as well as prognosis and clinical outcomes.

Cardio-oncology care manages the effects of cardiovascular morbidity and mortality in patients with cancer and survivors. Fadol emphasized the significant role of nurses in this evolving specialty.

“Cardio-oncology nurses serve as a bridge between cardiologists, oncologists, and the interprofessional team to provide seamless care for patients with cancer and concurrent cardiovascular disease and their families throughout the cancer journey—from diagnosis and treatment to survivorship and end-of-life care,” Fadol said.

Early detection and management of cardiovascular toxicities are crucial for patients to benefit from life-saving treatments. Cardiotoxicities in patients with cancer and survivors include:

• Arrhythmias
• Hypertension
• Hypotension
• Left ventricular dysfunction or heart failure
• Myocardial ischemia
• Myocarditis
• QT prolongation
• Thromboembolism

The Hypertension Domino Effect

Fadol emphasized the need to detect and treat hypertension. When uncontrolled, hypertension can lead to a chain of toxicities from left ventricular hypertrophy to diastolic impairment, heart failure, kidney failure, stroke, heart attack, arrhythmia, and death.

“Hypertension is the most common comorbidity in patients with cancer, and its incidence increases with certain anticancer treatment such as with tyrosine kinase inhibitors, used in the treatment of many types of cancer,” Fadol said. “In addition, other medications used in patients with cancer such as erythropoietin, corticosteroids, and nonsteroidal anti-inflammatory drugs, as well as injury to the carotid baroreceptor by cervical radiotherapy, can also increase blood pressure.

“The choice of antihypertensive agents must be individualized based on patients’ medical history and the specific properties of the different classes of antihypertensive agents, with careful consideration related to drug-drug interaction with anticancer treatment (e.g., calcium channel blocker and sorafenib). Nurses should be cognizant of these factors in the early identification, monitoring, and management of hypertension in patients with cancer,” Fadol explained.

Patient education on hypertension should include:

• Hypertension may be life threatening.
• List the potential side effects of medications and when to report them to their healthcare provider.
• Use a validated, automated blood pressure device, as well as on the correct procedure for blood pressure measurement.
• Keep a log of home blood pressure measurements.
• Adhere to your medications as prescribed.
• Notify your healthcare provider when stopping an anticancer agent.

The Role of Nurses in Interprofessional Collaboration

Fadol concluded by highlighting how an interprofessional team effort is critical for managing cardiovascular issues, with nurses at the forefront. “Nurses can facilitate successful collaboration as coordinators of patient-care activities ascribed by the multidisciplinary healthcare team,” she said. This includes:

• Inform patients, monitor adverse events, and evaluate outcomes.
• Provide education to patients, families, caregivers, and other healthcare team members.
• Facilitate continuity of care across settings and among providers.

“Nurses are at the heart of patient care in the cardio-oncology interprofessional team,” Fadol said.