Prevention and management of cardiovascular disease in adults with cancer: an International Cardio-Oncology Society (IC-OS) and Multinational Association of Supportive Care in Cancer (MASCC) clinical practice statement

PURPOSE: Cardiovascular (CV) toxicity is prevalent in cancer survivors due to shared risk factors, direct CV injury from cancer therapy (CT), and development/exacerbation of CV risk factors during treatment. Succinct guidance on the minimum standard of CV care required of cancer care providers (CCPs) can improve outcomes for survivors. This clinical practice statement (CPS) is aimed at CCPs focused on identification, prevention, and management of CVD in individuals with cancer.

METHODS: The International Cardio-Oncology Society and Multinational Association of Supportive Care in Cancer identified members with expertise across oncology, cardiology, and cancer survivorship. Key questions/areas of practice recommendations related to CV risk and CVD were identified across the cancer trajectory.Working groups performed targeted literature reviews and consensus was reached for all recommendations.

RESULTS: 5 over-arching clinical practice recommendations for CCPs were identified: (1) perform a CV risk assessment prior to starting CT (2) identify and facilitate CV-related care during CT; (3) ensure measures are taken to mitigate the risk of cancer therapy related CV toxicity (CTR-CVT) prior to and during CT; (4) monitor CV status and risk factors during therapy and refer to the appropriate health care provider if CV risk factors are uncontrolled or new signs/symptoms develop; and (5) re-assess CV risk following completion of CT (periodically for those with advanced disease on life long treatment) and develop a CV surveillance plan.

CONCLUSIONS: CCPs play a pivotal role in identifying and addressing CTR-CVT. This CPS provides specific, succinct, and actionable behaviours that can be readily implemented in cancer care globally.