Because cancer therapies can cause cardiovascular toxicity, the Society for Cardiovascular Angiography and Interventions (SCAI) released an expert consensus statement providing cardiologists, oncologists, and internal medicine physicians guidance for treating patients facing concomitant cardiovascular disease and cancer. This guidance was published in Catheterization and Cardiovascular Interventions (doi:10.1002/ccd.26379). Its goal is to increase the competency of cardiovascular professionals providing care to patients with cancer.
The number of cancer survivors has grown to approximately 14.5 million people in the United States, and 20 million survivors are expected by 2020. Anticancer therapies can result in angina, acute coronary syndromes, stroke, critical limb ischemia, arrhythmias, and heart failure. Furthermore, cancer is associated with a hypercoagulable state that increases the risk of acute thrombotic events. So, this patient population often needs invasive evaluation and management in the cardiac catheterization laboratory.
“Little data exists as cancer patients have been excluded from national percutaneous coronary interventions (PCI) registries and from most randomized trials involving PCI,” said Cezar A. Iliescu, MD, FSCAI, lead author of the document and director of the Cardiac Catheterization Laboratory at MD Anderson Cancer Center in Houston, Texas.
“Therefore, SCAI commissioned a consensus group to define the landscape and provide recommendations based on the available published medical literature and the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients.”
The guidance document discusses the mechanisms of vascular toxicities in cancer patients, which can be induced by radiation or chemotherapy. It also covers such aspects of cardiovascular care as screening, cardio-protection, percutaneous coronary interventions in patients with thrombocytopenia and anemia, fractional flow reserve, intravascular ultrasound and optical coherence tomography for complex intravascular assessment and deferring stenting, if possible. Discussions also include noncoronary interventional procedures in cancer patients such as endomyocardial biopsy and pericardiocentesis, as well as aortic valvuloplasty and transcatheter aortic valve implantation.
The guidance document suggests “collaboration between cardiologists and hematologists/oncologists is of prime importance.”