Cardiac monitoring is becoming an important part of breast cancer care. Breast cancer and cardiovascular disease (CVD) share many common risk factors, and it is estimated that by the median age of diagnosis, many patients with breast cancer will have established or subclinical CVD. In addition, a number of treatments for metastatic breast cancer are known to have cardiac effects. As such, there is a clear need to prevent, identify, and effectively manage cardiovascular events in patients with breast cancer. Current clinical practice for patients with metastatic breast cancer involves a comprehensive set of assessments to ensure efficacy and safety of treatment. Adding cardiac monitoring to the assessments already required for patients with breast cancer may improve survival and quality of life. Currently, cardiac monitoring is recommended for several breast cancer treatments, and guidelines related to cardiac monitoring are available. Here, we review the risk of CVD in patients with breast cancer, providing an overview of the cardiac events associated with standard therapies for metastatic breast cancer. We also assess the current clinical recommendations relating to cardiac monitoring, and practical management strategies for oncologists. Cardio-oncology is a growing medical subspecialty that promotes the need for effective cancer therapy while minimizing cardiac effects. Integrating cardiac monitoring into routine clinical practice may safeguard patients with metastatic breast cancer against adverse cardiac effects. IMPLICATIONS FOR PRACTICE: This review details the common risk factors associated with cardiovascular disease that are frequently observed in patients with metastatic breast cancer, as well as the adverse cardiac effects of many therapies that are commonly prescribed. The review also provides a rationale for routine and comprehensive cardiovascular assessment of all patients at baseline, and during and after therapy depending on the treatment and presence of risk factors for cardiovascular disease. The medical discipline of cardio-oncology is increasingly being recognized as an important part of clinical practice to ensure effective cancer therapy while maintaining cardiac health.
摘要
心脏监测逐渐成为乳腺癌治疗的重要环节。乳腺癌与心血管疾病 (CVD) 有许多共同的危险因素，据估计，按诊断的平均年龄，许多乳腺癌患者都有确诊的 CVD 或亚临床性 CVD。此外，现已明确许多转移性乳腺癌的治疗方法会对心脏产生影响。因此，必须预防、发现并有效管理乳腺癌患者的心血管事件。目前，临床实践中有一套全面的评估系统，对转移性乳腺癌患者进行评估，确保治疗的有效性和安全性。在乳腺癌患者的评估系统中增加心脏监测，可能会提高生存率和生活质量。目前，几种乳腺癌的治疗中推荐使用心脏监测，而且还有介绍心脏监测的指南。本文回顾了乳腺癌患者出现 CVD 的风险，介绍了与转移性乳腺癌标准治疗相关的心脏事件。同时，还评估了当前有关心脏监测的临床建议，以及为肿瘤医生提供的实际管理策略。心脏肿瘤学是一门不断发展的医学分支学科，促进了对有效癌症治疗的需要，同时降低了对心脏的影响。将心脏监测纳入常规临床实践，可以避免转移性乳腺癌患者受到心脏不良反应的影响。
实践意义:本文详细介绍了转移性乳腺癌患者中常见的与心血管疾病相关的危险因素，以及常用治疗方法对心脏的不良影响。本文还为所有患者在基线、治疗期间和治疗后，根据治疗方法和心血管疾病危险因素进行常规和全面的心血管评估提供了理论依据。心脏肿瘤学这门医学学科在临床实践中的认可度日益增长，可确保有效的癌症治疗，同时保持心脏健康。
Keywords: Cardiac dysfunction; Cardiac monitoring; Cardio‐oncology; Metastatic breast cancer.
© AlphaMed Press 2019.