Cardiotoxicities in Oncology Necessitate Nurse Vigilance

The presence of cardiotoxicities in oncology can accompany many diseases, and patients’ symptoms should be monitored along with patient characteristics and comorbidities, according to 2 experts.

In interviews with Oncology Nursing News, Kerry Skurka, BSN, RN, and Yvonne Callahan, MSN, RN, shared insights from their presentation on cardio-oncology at the 50th Annual Oncology Nursing Society Congress.

Skurka, a cardio-oncology nurse, and founder as well as co-chair of the International Cardio-Oncology Society Nursing, shared that cardiotoxicities can accompany many more treatments for cancer than providers may realize.

The intersection of cardiology and oncology is greater than nurses and advanced practice providers (APPs) may initially assume when entering oncology, explained Callahan, an assistant clinical instructor at Missouri State University and an oncology nurse at the specialty infusion center at Mercy Hospital.

Transcript

Skurka: We used to think that anthracyclines, the “red devil,” as people know, was the only cardiotoxicity. However, after the 2022 European guidelines that came out on cardiotoxicity, there is not any form of cancer treatment that doesn’t have some type of cardiotoxic side effects. Now that doesn’t mean everybody does, but the potential is there.

Callahan: This gets tricky, because sometimes we go into oncology thinking, “I don’t have to deal with all of that anymore,” so sometimes you just have to go back to the heart basics. So that was a little bit of what I had to do. And I actually just really hooked up with the American Heart Association, and they have great resources on just those basic signs and symptoms.

They have this self-check, which involves shortness of breath, swelling, weight gain, abdomen pain, if you’re having trouble sleeping. So those are some of the early symptoms that maybe, you’re having some cardiac issues, and the fatigue is kind of a little challenging, because we know that cancer treatment causes fatigue.

The key with that is, if you’re having fatigue and you’re just tired and you’re exhausted, it could be related to the treatment, but if you are having fatigue and shortness of breath, those are the combinations that you want to be watching for.

Skurka: The number one thing that I would say to those nurses is to do a cardiac risk assessment. There are several different types out there. [The American Society of Clinical Oncology] has one. The [National Comprehensive Cancer Network] has one. The most recent one is through the [European Society of Cardiology] that I talked about.

Basically, what that does on the front side, before they even start their cancer treatment, [the nurses] look at, what is the age of the patient? Are they 60 or 65? What do they have? Any heart issues already? Do they have they had a heart attack? Have they had open arrhythmia issues, or are there comorbidities? Is there hypertension, if they have that? Is that under control? Or do they smoke? Do they have high lipids? Those types of things we look at and see where they’re at.

And then, in addition to that, there is also a risk factor for each one of the drugs. You can look at the combination. So if somebody had some of those risks on, they had a history of heart disease, or they have moderate valvular disease, they had enough of those. And then let’s say we’re going to give them anthracycline, maybe then they would be a high risk.

But maybe somebody else comes along and they’re a younger patient, they don’t have hypertension, basically, they’re pretty healthy, except for their cancer, then they would be a low risk. And so it really helps to identify how you have to watch these patients through and if you need to get them a cardio-oncology consult with a physician and how you can watch them through their treatment.

This transcript has been edited for clarity and conciseness.