Cardio-oncology: before, during and after treatment

Who may need closer monitoring

Risk depends on the type and dose of treatment, earlier heart disease and factors such as arterial hypertension, diabetes, age and smoking. Anthracyclines can damage the heart muscle in a dose-related way; HER2-directed therapies can reduce left ventricular function; some targeted therapies cause hypertension, arrhythmias or thrombosis; immunotherapy can cause myocarditis; and radiation to the chest can damage the coronary vessels, valves and pericardium years later. Not every patient develops cardiotoxicity and not everyone needs the same frequency of checks.

Before treatment

The cardiologist reviews symptoms, history, medicines and the planned oncology regimen. Assessment includes an ECG, echocardiography and selected blood tests according to risk. Echocardiography assesses cardiac function, including the left ventricular ejection fraction (EF). When possible and indicated, global longitudinal strain (GLS) is also assessed, a more sensitive measure that may fall before the EF does; the European guideline recommends GLS in patients with cancer who have an echocardiogram, when available. Troponin and natriuretic peptides such as NT-proBNP help in monitoring, mainly in at-risk patients; they are not automatically required in every case.

During treatment

Checks are planned according to the therapy and individual risk. Results are compared with baseline values, because some changes can appear before symptoms. Report new shortness of breath, leg edema, palpitations, dizziness or reduced ability to exercise. Blood pressure is checked regularly and recorded as 130/80 mmHg (blood pressure 13 over 8). A raised biomarker or a change on echocardiography requires clinical interpretation; it does not by itself determine the cause.

After therapy ends and coordination

Assessment at the end of treatment helps determine further follow-up. Some patients need long-term checks because of the treatment received or problems that appeared during it; cardiology reviews take place every 6 months to a year, or sooner when the doctor considers it reasonable. Keep the regimens, documented doses and earlier tests.

The cardiologist and oncologist decide together on managing cardiovascular problems and any adjustment of anti-tumor therapy. Do not change heart medicines or oncology treatment yourself. The aim is to protect the heart while keeping the needed cancer treatment, whenever possible (see also heart failure).

Care at Tirana Polyclinic: we offer cardio-oncology assessment, ECG, echocardiography and Holter ECG as indicated, as well as interpretation of earlier tests. Follow-up is coordinated with the oncologist and the treating center.