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Coexisting Conditions: Cancer and Cardiovascular Disease

Coexisting Conditions: Cancer and Cardiovascular Disease. Objectives. The learner will be able to: State the potential effects of having the coexisting conditions of cancer and cardiovascular (CV) disease. Discuss nursing implications of caring for a patient with both cancer and CV disease.

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Coexisting Conditions: Cancer and Cardiovascular Disease

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  1. Coexisting Conditions:Cancer and Cardiovascular Disease

  2. Objectives The learner will be able to: • State the potential effects of having the coexisting conditions of cancer and cardiovascular (CV) disease. • Discuss nursing implications of caring for a patient with both cancer and CV disease.

  3. Cardiovascular Disease Overview • Refers to several types of heart conditions that can cause atherosclerosis • Includes a variety of cardiac, circulatory, or vascular problems • Leading cause of death in the U.S.; all ages and backgrounds can be affected. • Genetic conditions as well as some lifestyle factors can cause higher risk for CV disease. • Types of CV disease in the U.S.: • CAD resulting in myocardial infarction, angina, heart failure, arrhythmias • CVA, peripheral/arterial diseases, hyperlipidemia, hypertension

  4. Cardiovascular Disease Overview • Healthy People 2020 pledges to “improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events.” • Currently 81 million annual deaths from heart disease in the U.S. • 14%17% of cancer survivors report having heart or circulation problems.

  5. Potential Impact • Both cancer and CV disease are prevalent diseases. • New specialty is emerging called cardio-oncology. • Risk factors: • Individual patient factors, including history of CV disease • Prior cancer treatment affecting chest and/or heart physiology • Drug interactions and contraindications are a possibility. • Exacerbation of preexisting symptoms related to specific types of CV disease may occur when certain cancer treatments are administered, depending on the actions and side effects of the treatment. • Anthracycline drugs and some targeted therapy agents have been shown to cause some degree of cardiotoxicity. • Consideration of the two conditions along with cancer need to be addressed pre-, during, and post-treatment.

  6. Impact Examples • Preexisting CV disease can affect dose, schedule, and type of cancer treatment administered. • Types of cardiotoxicity due to cancer treatments: • Direct cardiac effects and associated cardiac systolic dysfunction • Cardiac ischemia • Arrhythmias • Pericarditis • Drug-induced repolarization abnormalities • Result of cardiotoxic agents can include: • Decreased pump function • Cardiac ischemia • Arrhythmias • Pericarditis • QT wave prolongation.

  7. Nursing Care Implications • Prevention of heart failure is the optimal goal. • Good pretreatment assessment is imperative. • Stay updated to provide safe patient care as guidelines to prevent or minimize cardiotoxicity are developed. • Coexisting conditions of heart disease and cancer require nurses to: • Gather thorough health history data. • Obtain pretreatment laboratory results. • Assess baseline and monitor vital signs closely. • Ensure that baseline and periodic cardiac function testing is ordered and completed, and results are available (EKG, 2D-echo, MUGA scan). • Assess and manage baseline and ongoing symptoms related to all conditions. • Monitor cumulative doses of cardiotoxic agents. • Assist with collaboration efforts between physicians. • Promote cardiovascular self-management efforts.

  8. References American Heart Association. (2012). What is cardiovascular disease (heart disease)? Retrieved from http://www.heart.org/HEARTORG/Caregiver/Resources/WhatisCardiovascularDisease/What-is-Cardiovascular-Disease_UCM_301852_Article.jsp Edgington, A., & Morgan, M.A. (2011). Looking beyond recurrence: Comorbidities in cancer survivors. Clinical Journal of Oncology Nursing, 15, E3E12. doi:10.1188/11.CJON.E3-E12 Healthy People 2020. (2012). Heart disease and stroke. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/ebr.aspx?topicid=21 National Institutes of Health, Medline Plus. (2012). Heart diseases. Retrieved from http://www.nlm.nih.gov/medlineplus/heartdiseases.html Rosenbaum, E.H. (2009). Comorbid disease (chronic illnesses) from Cancer Supportive Survivorship Care. Retrieved from http://www.cancersupportivecare.com/Survivorship/comorbidity.html U.S. National Library of Medicine, PubMed Health. (2012). A.D.A.M. Medical Encyclopedia: Coronary heart disease. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004449/

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