title: Cardiovascular disease after cancer therapy.
abstract: Improvements in treatment and earlier diagnosis have both contributed to increased survival for many cancer patients. Unfortunately, many treatments carry a risk of late effects including cardiovascular diseases (CVDs), possibly leading to significant morbidity and mortality. In this paper we describe current knowledge of the cardiotoxicity arising from cancer treatments, outline gaps in knowledge, and indicate directions for future research and guideline development, as discussed during the 2014 Cancer Survivorship Summit organised by the European Organisation for Research and Treatment of Cancer (EORTC). Better knowledge is needed of the late effects of modern systemic treatments and of radiotherapy to critical structures of the heart, including the effect of both radiation dose and volume of the heart exposed. Research elucidating the extent to which treatments interact in causing CVD, and the mechanisms involved, as well as the extent to which treatments may increase CVD indirectly by increasing cardiovascular risk factors is also important. Systematic collection of data relating treatment details to late effects is needed, and great care is needed to obtain valid and generalisable results. Better knowledge of these cardiac effects will contribute to both primary and secondary prevention of late complications where exposure to cardiotoxic treatment is unavoidable. Also surrogate markers would help to identify patients at increased risk of cardiotoxicity. Evidence-based screening guidelines for CVD following cancer are also needed. Finally, risk prediction models should be developed to guide primary treatment choice and appropriate follow up after cancer treatment.
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Berthe M P
authors.initials: BM
authors.lastname: Aleman
authors.affiliation: Department of Radiotherapy and Breast Unit, Champalimaud Foundation, Lisbon, Portugal.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Moser
authors.affiliation: Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Janine
authors.initials: J
authors.lastname: Nuver
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Suter
authors.affiliation: Department of Oncology and Haematology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Maja V
authors.initials: MV
authors.lastname: Maraldo
authors.affiliation: Department of Oncology and Haematology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Lena
authors.initials: L
authors.lastname: Specht
authors.affiliation: Department of Radiotherapy, Clinique des Grangettes, Geneva, Switzerland.
authors.forename: Conny
authors.initials: C
authors.lastname: Vrieling
authors.affiliation: Clinical Trial Service Unit, University of Oxford, Oxford, United Kingdom.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Darby
keywords: Cancer; Cardiovascular; Disease; Oncology; Therapy