Abstract
<p>There is a daily increase in the number of patients with malignant diseases, but with the advances in modern oncology research, the number of survivors treated with malignant diseases is becoming larger and larger. The survival rate after completing oncology therapy is increasing on a daily basis, so that malignant diseases belonging to the category of terminal diseases are now referred to as 'chronic illnesses'. In this specific group of patients, the risk from cardiovascular diseases is increasing nowadays. A new challenge for the future cardiologists will certainly pose the treatment of this group of patients. A cardiological approach in oncological patient treatment is an important issue. The cardiologist focuses on risk stratification and prevention of cardiovascular complications in the oncological patient in relation to his or her pre-existing condition, and in relation to the type of specific oncology therapy applied, and on further follow-up during therapy and after its completion. This implies that it is necessary to create cardio-oncology teams in our institutions treating the oncological patients. There is a considerable need for education in a new field, which presents the intersection between two clinical disciplines, i.e. cardiology and oncology, and for special education of cardiologists concerning all types of chemotherapy and their potential cardiotoxic effects. The oncologist, on the other hand, must be trained to recognize any possible early signs and symptoms of cardiac complications concerning the therapy applied and to seek further cardiac care for the patients. The aim of this review article is to assist the doctors treating this group of patients in their daily practice and to highlight the need for a multidisciplinary approach, as well as the creation of a cardio-oncology team for a comprehensive and integrative approach to a cardio-oncological patient.</p>
Highlights
Svjedoci smo svakodnevnog povećanja broja oboljelih od malignih bolesti, a zbog napretka savremene onkološke terapije povećava se i broj preživjelih liječenih od malignih bolesti
Prema preporukama European Society of Cardiology (ESC)-a za praćenja pacijenata u toku hemioterapije, navodi se da praćenje ove grupe pacijenata ultrazvukom ili biomarkerima treba da bude personalizovano prema svakom pacijentu i u odnosu na njegove bazične kardiovaskularne faktore rizika, kao i u odnosu na specifični hemioterapijski protokol, ali svakako treba da obuhvati bazični pregled ultrazvukom, tj. prije započinjanja hemioterapije, zatim praćenje u toku hemioterapije i praćenje nakon završetka hemioterapije
U SAD se primjenjuje dexrazoxan kod pacijenata sa visokim rizikom za CTRCD, a koji su na terapiji antraciklinima i njegova upotreba u Evropi je sa ograničenim indikacijama [5]
Summary
Svjedoci smo svakodnevnog povećanja broja oboljelih od malignih bolesti, a zbog napretka savremene onkološke terapije povećava se i broj preživjelih liječenih od malignih bolesti. Na kardiologu je procjena i prevencija rizika nastanka kardiovaskularnih komplikacija kod onkološkog bolesnika u odnosu na njegovo preegzistentno stanje, kao i na vrstu primijenjene specifične onkološke terapije, njegovo dalje praćenje tokom terapije i nakon završene terapije. Zbog toga postoji sve veća potreba za razvojem kardioonkologije kao jedinstvene interdisciplinarne supspecijalizacije ili edukacije čiji cilj bi upravo bila ova sve veća grupa bolesnika i njihovo praćenje kako u toku terapije tako i nakon terapije, imajući u vidu da se efekat pojedinih hemioterapeutika može ispoljiti i nakon 10-20 godina od završetka terapije [4]. Prema preporukama ESC-a za praćenja pacijenata u toku hemioterapije, navodi se da praćenje ove grupe pacijenata ultrazvukom ili biomarkerima treba da bude personalizovano prema svakom pacijentu i u odnosu na njegove bazične kardiovaskularne faktore rizika, kao i u odnosu na specifični hemioterapijski protokol, ali svakako treba da obuhvati bazični pregled ultrazvukom, tj. Oba dokumenta su saglasna i u tome da ne postoji dovoljno dokaza da se podrži prekidanje ili odlaganje terapije na osnovu biomarkera ili longitudinalnog naprezanja (strain-a)
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