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Cuomo A, Mercurio V, Varricchi G, Galdiero MR, Rossi FW, Carannante A, Arpino G, Formisano L, Bianco R, Carlomagno C, De Angelis C, Giuliano M, Matano E, Picardi M, Salvatore D, De Vita F, Martinelli E, Della Corte CM, Morgillo F, Orditura M, Napolitano S, Troiani T, Tocchetti CG. Impact of a cardio-oncology unit on prevention of cardiovascular events in cancer patients. ESC Heart Fail 2022; 9:1666-1676. [PMID: 35362255 PMCID: PMC9065840 DOI: 10.1002/ehf2.13879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 12/29/2022] Open
Abstract
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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Affiliation(s)
- Alessandra Cuomo
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valentina Mercurio
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy
| | - Gilda Varricchi
- Internal Medicine and Clinical Immunology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, Naples, Italy
| | - Maria Rosaria Galdiero
- Internal Medicine and Clinical Immunology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Francesca Wanda Rossi
- Internal Medicine and Clinical Immunology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Antonio Carannante
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Grazia Arpino
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Luigi Formisano
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberto Bianco
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Chiara Carlomagno
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Carmine De Angelis
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Mario Giuliano
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Elide Matano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Ferdinando De Vita
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Erika Martinelli
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | | | - Floriana Morgillo
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Michele Orditura
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Stefania Napolitano
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Teresa Troiani
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Carlo G Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
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Martinez HR, Beasley GS, Goldberg JF, Absi M, Ryan KA, Guerrier K, Joshi VM, Johnson JN, Morin CE, Hurley C, Morrison RR, Rai P, Hankins JS, Bishop MW, Triplett BM, Ehrhardt MJ, Pui CH, Inaba H, Towbin JA. Pediatric Cardio-Oncology Medicine: A New Approach in Cardiovascular Care. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121200. [PMID: 34943396 PMCID: PMC8699848 DOI: 10.3390/children8121200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/11/2022]
Abstract
Survival for pediatric patients diagnosed with cancer has improved significantly. This achievement has been made possible due to new treatment modalities and the incorporation of a systematic multidisciplinary approach for supportive care. Understanding the distinctive cardiovascular characteristics of children undergoing cancer therapies has set the underpinnings to provide comprehensive care before, during, and after the management of cancer. Nonetheless, we acknowledge the challenge to understand the rapid expansion of oncology disciplines. The limited guidelines in pediatric cardio-oncology have motivated us to develop risk-stratification systems to institute surveillance and therapeutic support for this patient population. Here, we describe a collaborative approach to provide wide-ranging cardiovascular care to children and young adults with oncology diseases. Promoting collaboration in pediatric cardio-oncology medicine will ultimately provide excellent quality of care for future generations of patients.
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Affiliation(s)
- Hugo R. Martinez
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
- Correspondence:
| | - Gary S. Beasley
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Jason F. Goldberg
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Mohammed Absi
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Kaitlin A. Ryan
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Karine Guerrier
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Vijaya M. Joshi
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Jason N. Johnson
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
| | - Cara E. Morin
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Caitlin Hurley
- Division of Critical Care Medicine, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (C.H.); (R.R.M.)
- Department of Bone Marrow Transplantation & Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Ronald Ray Morrison
- Division of Critical Care Medicine, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (C.H.); (R.R.M.)
| | - Parul Rai
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (P.R.); (J.S.H.)
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (P.R.); (J.S.H.)
| | - Michael W. Bishop
- Division of Solid Tumor, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Brandon M. Triplett
- Department of Bone Marrow Transplantation & Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Matthew J. Ehrhardt
- Division of Cancer Survivorship, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Ching-Hon Pui
- Division of Leukemia/Lymphoma, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (C.-H.P.); (H.I.)
| | - Hiroto Inaba
- Division of Leukemia/Lymphoma, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (C.-H.P.); (H.I.)
| | - Jeffrey A. Towbin
- Division of Pediatric Cardiology, The Heart Institute at Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (G.S.B.); (J.F.G.); (M.A.); (K.A.R.); (K.G.); (V.M.J.); (J.N.J.); (J.A.T.)
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