Nurses' Role in Cardiotoxicity in Cancer Survivors

Jacqueline B. Vo, PhD, RN, MPH

As the number of cancer survivors continues to grow, it is imperative that clinicians closely monitor therapy-related cardiac toxicity after patients finish their treatment. In particular, survivors who were treated with anthracyclines and/or trastuzumab (Herceptin) may be at an increased risk.

“As advanced practice nurses, it’s important to understand current clinical guidelines for cancer survivors in order to educate and support survivors,” said Jacqueline B. Vo, PhD, RN, MPH, a cancer prevention fellow at the National Cancer Institute, in a presentation at the 2020 ONS Bridge Virtual Conference.

“Both anthracyclines and trastuzumab can cause left-sided heart failure. The risk of heart failure increases significantly when both of these drugs are given together,” she said.

In her research, which was presented at the 2020 ONS Bridge Virtual Meeting, Vo analyzed survivorship guidelines regarding cardiovascular care of cancer survivors. She looked at the blueprints laid out from 5 leading organizations: The American Society for Clinical Oncology (ASCO); The American Cancer Society (ACS); the European Society for Medical Oncology (ESMO); the National Comprehensive Cancer Network (NCCN); and the American Heart Association (AHA).

AHA, ASCO and ESMO all recommended baseline echocardiograms of the left ventricular ejection fraction for patients who received anthracyclines and/or trastuzumab. Additionally, the NCCN deemed low baseline ejection fraction (under 55%) as a risk for developing cardiac toxicity.

During treatment, the AHA, ASCO, and ESMO all recommend screening every 3 months while patients are undergoing cardiotoxic treatment, and AHA, ASCO, ESMO, and the NCCN all recommended screening 1 year after a patient completes treatment.

The ASCO/ACS survivorship guidelines reference NCCN cardiotoxicity guidelines, which focuses on monitoring lipid levels, cardiovascular monitoring, and patient education on healthy lifestyles.

Only one organization — ESMO – recommended the long-term monitoring.

Vo said that nurses can play a key role in ensuring that their patients get echocardiograms, when recommended or necessary. It is also important for them to understand not only the treatments that patients received, but also heir individual lifestyles that can contribute to the development of heart problems down the line.

“We also want to provide survivorship care that is tailored to the patient, including modifying the risk factors and also educating the patient on risk factors,” Vo said. These factors can include smoking cessation, maintaining a health weight, and getting enough physical activity.

Cardio-oncology is a growing field, and as more clinicians understand the impact that cancer treatment has on the heart, better interventions and prevention strategies can be crafted.

There are also ongoing studies examining lifestyle interventions such as physical activity and diet, as well as pharmacologic studies looking at drugs such as angiotensin-converting enzyme (ACE) inhibitors in preventing cardiotoxicity.

“With this discipline, there’s a growing quantity of cardio-oncology clinics, specifically in academic medical centers,” Vo said. “With this, there’s also a need for nurses to be trained in cardiology and cardio-oncology as well.”

Reference

Vo JB. Clinical cardiovascular guidelines for adult cancer survivors: implications for oncology nursing practice. Presented at: 2020 ONS Bridge Virtual Conference. September 8, 10, 15, and 17. 2607356/vo_reviewing-clinical-cardiovascular-guidelines-for-adult-cancer-survivors-implications-for-oncology-nursing-practice-self-recording-on-demand