Rationale for setting up a cardio-oncology unit: our experience at Mayo Clinic.
Rationale for setting up a cardio-oncology unit: our experience at Mayo Clinic.
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DOI：
10.1186/s40959-016-0014-2
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发表时间：
2016-04-19
期刊：
影响因子：
--
通讯作者：
Villarraga, Hector R
中科院分区：
文献类型：
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作者：
Barros-Gomes, Sergio;Herrmann, Joerg;Villarraga, Hector R
背景：心血管并发症的诊断和管理已成为肿瘤学家、心脏病专家、外科医生、介入放射科医生、放射治疗医生、内科医生、护士、药剂师、管理人员和所有参与癌症患者护理的利益相关者关注的临床问题。抗癌疗法延长了癌症患者的生命，但对一些人来说，这种益处被不利的心血管效应削弱了。方法：本文旨在概述建立心肿瘤科的基本原理，并反思自己建立心肿瘤科的经验，最后提出对癌症和心血管疾病患者进行评估和管理的一些基本考虑。结果：心脏毒性可导致充血性心力衰竭和心源性死亡。事实上，化疗相关的心功能障碍可能是所有类型的心肌病中预后最差的一种，并且对肿瘤患者的发病率和死亡率有着深远的影响。其他复杂的临床情况涉及癌症患者，他们可能从一种高治愈性药物中受益，但由于伴随的心血管疾病而面临给药的限制。事实上，在个体患者心血管状况的背景下，癌症治疗方案的收益和风险之间的平衡有时是非常具有挑战性的。因此，在肿瘤学家、血液学家、心脏病学家等之间形成了一个多学科综合方法的亚专科，以解决这些问题，称为心脏肿瘤学。心脏肿瘤学以多学科的方式，对患有心血管疾病或有心脏毒性风险的癌症患者进行预防、检测、监测和治疗。在这个领域，心脏病专家协助肿瘤学家和血液学家提出心血管方面的建议。这可以通过电子咨询或面对面评估来调解。结论：心脏肿瘤学是一个亚专科，以跨学科的方式协助有或无心血管疾病的癌症患者的整体护理。我们相信这种在医疗团队成员之间分担责任和经验的伙伴关系可以潜在地减少癌症治疗相关的心血管并发症并改善临床结果。
BACKGROUND: The diagnosis and management of cardiovascular complications have become a clinical concern for oncologists, cardiologists, surgeons, interventional radiologists, radiation therapy physicians, internists, nurses, pharmacists, administrators, and all the stakeholders involved in the care of cancer patients. Anticancer therapies have extended the lives of patients with cancer, but for some this benefit is attenuated by adverse cardiovascular effects.METHODS: This review article aims to provide an overview of the rationale of setting up a cardio-oncology unit and reflect on our own experience establishing this service, and conclude with some fundamental aspects of consideration for evaluation and management of patients with cancer and cardiovascular diseases.RESULTS: Cardiotoxicity can lead to congestive heart failure and cardiac death. In fact, chemotherapy-related cardiac dysfunction may carry one of the worst prognoses of all types of cardiomyopathies, and has a profound impact on morbidity and mortality in oncology patients. Other complex clinical situations involve cancer patients who might benefit from a highly curative drug in terms of cancer survival but face limitations of its administration because of concomitant cardiovascular diseases. Indeed, the balance between the benefits and risks of the cancer therapy regimen in the context of the cardiovascular status of the individual patient can sometimes be extraordinarily challenging. A subspecialty with a multidisciplinary integrative approach between oncologists, hematologists, cardiologists, among others has thus emerged to address these issues, termed cardio-oncology. Cardio-oncology addresses the spectrum of prevention, detection, monitoring and treatment of cancer patients with cardiovascular diseases, or at risk for cardiotoxicity, in a multidisciplinary manner. In this field, cardiologists assist oncologists and hematologists with cardiovascular recommendations. This can be mediated through e-consultations or face-to-face evaluations.CONCLUSION: Cardio-oncology is a subspecialty that assists in the overall care of cancer patients with and without cardiovascular disease in an interdisciplinary fashion. We believe that this partnership of sharing responsibilities and experiences among health-care team members can potentially decrease cancer therapeutics-related cardiovascular complications and improve clinical outcomes.