Cardiac Toxic Chemotherapy and Cancer Survivorship

With remarkable progress in cancer diagnosis and therapy, there are growing numbers of cancer survivors with almost 15 million current survivors in the United States. Because of the recognition that cardiovascular morbidity and mortality play an important role in outcomes of cancer survivors, understanding the unique cardiac needs of survivors and existing evidence for care is essential to cardio-oncology and survivorship care. Cancer survivors are a heterogeneous population with several potentially cardiotoxic exposures and several potential, and not mutually exclusive, complications of therapy (for instance cardiomyopathy and premature atherosclerosis) making uniform guidelines difficult to implement. Using case-based presentations, this chapter will address basic assessment and management of cardiac function and risk in cancer survivors. Best practices for assessment of survivors based on treatment modality (i.e., chemotherapy and/or radiation therapy) and host-related factors (i.e., age at diagnosis and pre-existing risk factors) are described.