European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment.

AIMS: To develop quality indicators (QIs) for the evaluation of the prevention and management of cancer therapy-related cardiovascular toxicity. METHODS AND RESULTS: We followed the European Society of Cardiology (ESC) methodology for QI development which comprises (i) identifying the key domains of care for the prevention and management of cancer therapy-related cardiovascular toxicity in patients on cancer treatment, (ii) performing a systematic review of the literature to develop candidate QIs, and (iii) selecting of the final set of QIs using a modified Delphi process. Work was undertaken in parallel with the writing of the 2022 ESC Guidelines on Cardio-Oncology and in collaboration with the European Haematology Association, the European Society for Therapeutic Radiology and Oncology and the International Cardio-Oncology Society. In total, 5 main and 9 secondary QIs were selected across five domains of care: (i) Structural framework, (ii) Baseline cardiovascular risk assessment, (iii) Cancer therapy related cardiovascular toxicity, (iv) Predictors of outcomes, and (v) Monitoring of cardiovascular complications during cancer therapy. CONCLUSION: We present the ESC Cardio-Oncology QIs with their development process and provide an overview of the scientific rationale for their selection. These indicators are aimed at quantifying and improving the adherence to guideline-recommended clinical practice and improving patient outcomes.

Radiotherapy is safe in patients with implantable cardiac devices. Analysis of a systematic interrogation follow-up.

INTRODUCTION: The number of patients who have a cardiac implantable electronic device (CIEDs) that undergo a course of radiotherapy is increasing due to the ageing population. The majority of clinical studies only evaluate any CIED malfunction at the end of a course of irradiation or in a case of there being symptoms of possible malfunction. As a result, little data has been collected on CIED status acquired during an active course of irradiation. MATERIAL AND METHODS: We aimed to evaluate the correct functioning of a CIED during a course of radiotherapy. So, a retrospective analysis was made of all patients having CIEDS in a single institution during their course of radiotherapy. All CIEDs were systematically checked before and during the course of radiotherapy according to the risk of device failure and patient dependence. RESULTS: Data was analysed from 56 patients (43 men, 13 women) with a mean age of 78.2 years, of whom 87.5% of the patients carried a pacemaker (PM), the 39% of the patients were PM dependent, and the remaining patients carried an implantable cardioverter-defibrillator (ICD). An observable dose of irradiation was evident in only 10 cases. 69.1% of the CIEDs were checked daily and the remainder were checked weekly. During the radiotherapy course, 82% of the patients did not complain of any cardiological event. The CIED of five patients experienced an increase in the threshold and, in another case, a sudden reduction in the duration of the battery was reported. Another patient with a CIED experienced a cardiac insufficiency episode triggered by a ventricular tachycardia. CONCLUSION: In conclusions, although adverse clinical events from exposure of a CIED to irradiation are rare, they can appear in any group of risk. No dose-dependency was observed on the malfunction of the CIED.

Current functioning of cardio-oncology units in Spain.

PURPOSE: The aim of the current survey was to describe the functioning of cardio-oncology (C-O) units in Spain. METHODS: All members of the Spanish Society of Cardiology pertaining to scientific communities related to C-O received questionnaires on the existence of specific programs at their institutions. A second, more extensive questionnaire was sent to the centers which reported C-O organization. RESULTS: We identified 56 centers with C-O programs of which 32 (62.5%) replied to the extended questionnaire. 28% of all centers reported having a multidisciplinary unit involving specialists in several areas. More than 80% of the centers developed surveillance protocols locally adapted which included advanced echocardiographic techniques (68%) or troponin (82%). CONCLUSIONS: The number of institutions with C-O programs is still limited but higher than reported in a survey in 2017. Development of multidisciplinary units of C-O should be promoted to improve the cardiovascular health of cancer patients.

Management of patients with implanted cardiac devices during radiotherapy: results of a Spanish survey in radiation oncology departments

Background: There is an increasing number of patients with cardiac implantable electronic devices (CIED), either pacemakers or defibrillators, who are receiving a course of radiotherapy. Several guidelines have been published by national societies, but no Spanish national guidelines for management of these patients have been published. More importantly, national clinical practice regarding these patients is not standardised. Materials and methods: Members of the Spanish Breast Cancer Radiation Oncology Group (GEORM in Spanish) were surveyed through an online questionnaire on behalf of the Spanish radiation oncology departments. Results: Only 39.3% of the Spanish radiation oncology departments have policies aimed at CIED carrier patients. Regardless of that, 96.4% of those who responded to the survey refer these patients to their Cardiology department before the start of the course of radiotherapy, and 17.8% of respondents said to manipulate the CIED without any cardiology department direction. A wide range of responses was obtained related to concepts such as "distance from the irradiation field to the CIED" or "safe accumulated doses". Conclusions: Our results demonstrate the need for national guidelines for CIED patients and the need to promote educational activities addressed to standardise clinical management of these patients in the radiation oncology departments

No disponible

Management of patients with implanted cardiac devices during radiotherapy: results of a Spanish survey in radiation oncology departments.

BACKGROUND: There is an increasing number of patients with cardiac implantable electronic devices (CIED), either pacemakers or defibrillators, who are receiving a course of radiotherapy. Several guidelines have been published by national societies, but no Spanish national guidelines for management of these patients have been published. More importantly, national clinical practice regarding these patients is not standardised. MATERIALS AND METHODS: Members of the Spanish Breast Cancer Radiation Oncology Group (GEORM in Spanish) were surveyed through an online questionnaire on behalf of the Spanish radiation oncology departments. RESULTS: Only 39.3% of the Spanish radiation oncology departments have policies aimed at CIED carrier patients. Regardless of that, 96.4% of those who responded to the survey refer these patients to their Cardiology department before the start of the course of radiotherapy, and 17.8% of respondents said to manipulate the CIED without any cardiology department direction. A wide range of responses was obtained related to concepts such as "distance from the irradiation field to the CIED" or "safe accumulated doses". CONCLUSIONS: Our results demonstrate the need for national guidelines for CIED patients and the need to promote educational activities addressed to standardise clinical management of these patients in the radiation oncology departments.

Técnicas de imagen en el diagnóstico y manejo del paciente diabético / Imaging techniques in diagnosis and management of patients with diabetes

La diabetes mellitus es una de las enfermedades con mayor impactoen la población española y en el sistema sanitario, como consecuenciade su elevada prevalencia y de los costes directos e indirectosque genera. La prevalencia de diabetes en pacientes concardiopatía isquémica en España es aproximadamente del 20%. Lafisiopatología y la repercusión clínica varían en función del lechovascular afectado. En pacientes con diabetes tipo 2, el desarrollo dela placa de ateroma no sólo es más rápido, sino que los mecanismosresponsables parecen diferir respecto a los de los pacientes nodiabéticos. En este escenario, las técnicas de imagen cardiaca adquierenun papel importante para detectar a los pacientes asintomáticoscon riesgo aterotrombótico alto. La ecocardiografía es actualmentela técnica de elección en la valoración inicial del paciente consíntomas o sospecha de disfunción cardiaca. La valoración medianteecocardiografía de la función sistólica y diastólica, basal y tras unesfuerzo, aporta información diagnóstica y pronóstica para el manejode los pacientes diabéticos. Sin embargo, a pesar de su potencialutilidad, el criterio para seleccionar a los pacientes diabéticos quepodrían beneficiarse de un cribado no invasivo de enfermedad coronariaes todavía muy controvertido, y se requieren estudios prospectivospara determinar cuáles son las pruebas de imagen cardiacamás útiles en estos pacientes(AU)

Diabetes mellitus is one of the diseases with higher impact in theSpanish community and health care system as a consequence of itshigh prevalence and their associated direct and indirect costs. Theprevalence of diabetes in patients with coronary disease in Spain isapproximately of 20%. Both physiopathology and clinical manifestationsare dependent on the location of vascular abnormalities. In patientswith type 2 diabetes, the development and progression of theatheroma plaque are not only more rapid but it seems that prevailingmechanisms are different than in non-diabetic patients. Therefore,cardiac imaging techniques may play a key role to detect asymptomaticpatients with high atherothrombotic risk. Currently, echocardiographyis the gold-standard technique for the initial valuation of thesymptomatic patient or with suspected cardiac dysfunction. Echocardiographicevaluation of systolic and diastolic ventricular functionboth at rest and under stress provides important diagnostic andprognostic information for the management of diabetic patients.However, despite its potential usefulness, the criterion to select thediabetic patients who might benefit from a non invasive screening ofcoronary disease is still controversial and prospective studies arenecessary to determine which imaging techniques are more useful indiabetic patients(AU)

Prevención del cáncer pediátrico / Prevention in childhood cancer

A pesar de las numerosas evidencias basadas en la observación, el establecimiento de la relación causal entre medio ambiente y cáncer pediátrico (CP) ha estado lleno de dificultades metodológicas. Nosotros presentamos un análisis de la naturaleza del problema para proponer algunos de los aspectos relevantes y concretos de utilidad en la práctica pediátrica para la prevención del CP y del cáncer adulto desde la infancia entre los que se encuentran: a) crear unidades de salud medioambiental pediátrica; b) desarrollar la historia clínica medioambiental en el niño con cáncer; c) incorporar la “hoja verde” a los programas de atención del niño sano; d) programa de minimización en el uso de la radiación ionizante; e) implementar las consultas de lactancia materna y deshabituación del consumo de tabaco en pediatría; f) divulgar y fomentar el consumo de una dieta “mas vegetariana”; g) colaborar en el desarrollo de la guía de acción medioambiental escolar (AU)

Despite the various types of observational evidence, the establishment of a causal relationship between the environment and paediatric cancer (PC) has been fraught with inherent methodological difficulties. We have carry out an analysis of the nature of the problem to propose some of the useful and concrete paediatric aspects to prevent of the PC and the adult cancer form the childhood. In this paper, we emphasized the following: a) to create Paediatric Environmental Health Speciality Units; b) to integrate the paediatric environmental history for all children with cancer; c) to incorporate the “green page” to the well-child visit programs; d) to diminish the use of the ionizing radiation; e) to implement breastfeeding and smoking cessation services into paediatric department; f) to disclose and foment the intake of a more vegetarian diet; g) to develop of the guide of school environment health (AU)