Heart Disease in Cancer Patients and Cancer in Patients with Heart Disease: How to Manage This Double Problem?

Dear colleagues,

As life expectancy increases, more patients will suffer from both heart disease and malignancy, either simultaneously or consecutively. There are several reasons for this.

• Both conditions have common risk factors, such as ageing, obesity, and the use of tobacco.
• Furthermore, treatment of malignancy can be responsible for heart disease. Most notorious is the use of cardiotoxic anthracyclines, which can be responsible for irreversible long-term heart failure. Other examples are arrhythmias, coronary vasospasm, and thrombosis caused by other agents. Although radiotherapeutic protocols have improved, heart disease resulting from radiation still poses problems for some patients.
• Difficult situations can also arise in patients needing antithrombotic medication after PCI, who develop cancer in the first year after the procedure, or who suffer from chronic hematologic disease.
• A very serious—but relatively rare—condition is endocarditis caused by Streptococcus gallolyticus and enterococci, which is often associated with colonic neoplasia. The management of this difficult subgroup is by no means under control.

These examples are by no means exhaustive. Cardiologists and oncologists reside in two different worlds which have long remained separate. However, given these problems, they need to communicate to one another. Several questions can be asked of the cardiologists: How can I ensure that a cancer patient receives the optimal oncological treatment, especially when cardiotoxic treatment is involved? How can I anticipate and treat these patients most accurately? The following question can also be posed to the oncologists: What is the best option (in terms of quality of life and survival) for any cancer patient who is confronted with concomitant or subsequent heart disease? To answer these questions, the involvement of dedicated oncocardiologic and cardiooncologic teams will be essential.

Prof. Dr. Wilhelm Mistiaen
Guest Editor

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• heart disease
• heart surgery
• malignancy
• cardiotoxicity
• survival
• quality of life
• interdisciplinary teamwork