Cross-border conversations . . . When an oncologist meets a cardiovascular doctor...

Recently, a new dialogue between oncologists and cardiovascular doctors was held in the live broadcast of "doctor's Daily".Professor Xia Yunlong from the First Affiliated Hospital of Dalian Medical University and Professor Ma Fei of Cancer Hospital of Chinese Academy of Medical Sciences were invited, and were presided over by Professor Yang Jinggang of Fuwai Hospital, Chinese Academy of Medical Sciences.as a new interdisciplinary, oncocardiology has attracted more and more attention in recent years.in 2020, the development of oncocardiology in China has entered a new stage. With the promotion of Professor Xia Yunlong, June 5 of each year is set as the cancer heart disease day, and large-scale publicity activities are held.at the beginning of the live broadcast, Professor Yang Jinggang pointed out the embarrassing situation that doctors of oncology and cardiology shuffled the buck after receiving patients with cancer and heart disease.question 1: how do oncology and cardiovascular departments work together to overcome the difficulties? Prof. Ma Fei: with the rapid development of cancer treatment, the survival period of patients is getting longer and longer. On the one hand, anti-tumor drugs prolong the survival period of patients and bring about cardiovascular problems; on the other hand, with the prolongation of survival period of patients, like ordinary people, they will inevitably face cardiovascular problems."healthy China 2030 health strategic plan" requires that the overall 5-year survival rate of cancer be increased by 15% by 2030.increasing the risk of cancer-related death and increasing the risk of non cancer death (such as cardiovascular disease) in cancer patients will help to achieve the previous goal.it is necessary to improve the medical workers' concept of co management of tumor and cardiovascular disease, not to shirk responsibility and share the responsibility. At the same time, we should do a good job in popularizing science. Cancer patients are also high-risk groups of cardiovascular disease, so we should be vigilant.Professor Xia Yunlong: cardiology in English, cardiac oncology in English, In order to avoid narrow understanding of it as long cardiac tumor, China finally defined it as oncocardiology, that is, cardiac events in the field of tumor. It includes four aspects: first, cardiovascular toxicity caused by drugs in the process of anti-tumor treatment, damage to the heart, etc., how to detect and early warn early, and how to intervene and treat.secondly, how to establish a high-quality and most appropriate treatment scheme for patients with tumor complicated with cardiovascular disease, instead of pressing the gourd to make a gourd.Third, there are many common risk factors for the two diseases, such as smoking, obesity, sedentary, hypertension, diabetes, etc. it is very necessary to study the related mechanisms and effectively intervene the common risk factors.fourth, cardiovascular tumors, such as myxoma, sarcoma, rhabdomyosarcoma, or metastatic tumor, although low incidence rate, but not to be ignored.at present, the most important thing is to pay attention to how to protect cardiovascular and avoid cardiovascular drug toxicity in the process of anti-tumor treatment.question 2: should we actively intervene in blood lipids in patients with atherosclerotic cardiovascular disease? Prof. Ma Fei: according to a baseline survey of breast cancer in China, 40% of breast cancer patients have dyslipidemia before treatment, and 20% ~ 30% of normal patients have dyslipidemia after anti-cancer treatment. Adding up, up to 2 / 3 of breast cancer patients will have dyslipidemia.to our surprise, less than 1 / 20 of the patients with dyslipidemia were treated with intervention measures, which was far lower than that of normal hyperlipidemia patients.studies have found that statins do not increase the incidence of cancer, and do not affect the therapeutic effect of tumors. for breast cancer patients, the patients with cardiovascular abnormalities and dyslipidemia also have a longer survival time compared with those without statins. therefore, tumor patients with dyslipidemia can be treated with statins just like other patients. Professor Xia Yunlong: our team recently published a cohort study of 100000 people, followed up for 16 years, and studied the correlation between blood lipid level and cardiovascular disease and tumor. the results showed that the lower the level of LDL, the lower the incidence of cardiovascular disease. However, the curve of tumor incidence rate was not consistent with that of cardiovascular system and was separated. when the blood lipid is lower than the normal value, the tumor incidence rate is relatively high; when the blood lipid is within the normal range, the tumor incidence curve also hovers at low frequency. the lower the blood lipid, the lower the cardiovascular risk. However, there is not enough evidence-based medical evidence on the impact on the risk of cancer and other diseases. on the other hand, statins have protective effects on myocardium due to their anti-inflammatory and anti-oxidation effects, which exceeds the benefits brought by blood lipid lowering itself. question three parts of cancer drugs may cause myocardial injury. Is cardiovascular safety test necessary before tumor drugs are marketed? Professor Xia Yunlong: almost all drugs in the world will be evaluated for their safety before they are put on the market, including cardiovascular indicators. however, in the field of cancer, due to the particularity of its disease, the survival period of patients is not long. In the research and development, as long as the overall survival period of patients is prolonged, it is necessary to quickly go on the market, thus the research on adverse reactions is missing. in the process of developing anti-tumor drugs, how to reasonably evaluate the cardiovascular safety is an important topic. existing data show that different types of anti-tumor drugs have different cardiovascular toxicity spectrum, such as anthracycline drugs have a greater impact on cardiac function, arsenic can affect the QT interval of ECG. therefore, it is necessary to formulate evaluation scheme according to different drugs. there is a certain lack of work in this area in China. We propose to evaluate the cardiovascular safety indicators of tumor drugs before they are put on the market. Prof. Ma Fei: in the process of tumor drug research and development, we will not only pay attention to cardiovascular safety, but also pay attention to other aspects. If some drugs will lead to interstitial lung disease, it is also the focus of attention. however, many patients with advanced cancer have limited survival time and treatment methods, and even there is no standard treatment for the disease. Therefore, new drugs become their only lifesaving straw, which has the status of orphan drugs. at this time, if the safety is put in the first place, and the long-term and large sample safety verification is carried out, many patients will miss the chance to save their lives. at this time, it is necessary to give priority to the fast track for listing. after rapid marketing, let patients survive first, and then conduct post marketing safety assessment. for the cancer with many standard treatment methods, the earlier the drug is used, the more strict the pre marketing safety assessment is. safety assessment should be treated differently according to different situations. question 4: how to improve the understanding of cardiovascular disease prevention and treatment among oncologists? How to establish a standardized diagnosis and treatment process of cardiovascular disease in cancer patients? Prof. Ma Fei: clinically, oncologists do not pay enough attention to cardiovascular symptoms. on the one hand, symptoms such as chest tightness and shortness of breath are the basic symptoms of lung cancer and other types of cancer, and doctors first consider the cause of tumor; on the other hand, oncologists do not know enough about cardiovascular disease. I did epidemiological research on cancer patients with blood lipid before, not because it is more serious than heart failure, but because it has an objective detection index. If even the objective abnormal number can not arouse the attention of oncologists, how can we ask cancer doctors to pay attention to the heart failure problem of patients in the future. because of the lack of understanding of cardiovascular disease symptoms, oncologists need the help of cardiovascular doctors. therefore, in this case, it is necessary to establish a set of process or path, so that oncologists can easily enter the path and find the clues of cardiovascular disease. therefore, we have established a Chinese breast cancer follow-up and concomitant disease management guidelines to pay attention to its concomitant diseases and cancer follow-up norms. we hope that not only breast cancer, but also all other tumors have a standardized diagnosis and treatment path. after discovering cardiac abnormalities, oncologists should seek the help of cardiologists, and the two departments should cooperate to solve the problem. Professor Xia Yunlong: early screening is very important. sometimes, when the patient has chest tightness and palpitation symptoms, a cardiac ultrasound may find that the cardiac ejection fraction has decreased; if you do dynamic electrocardiogram, you may find arrhythmia; if you do myocardial marker detection, you may find myocardial damage. therefore, when managing cancer patients, oncologists should be highly alert to potential cardiovascular risks, think of the cardiovascular risks that may occur in the treatment process, and carry out necessary screening and monitoring to prevent the disease in the bud. The First Affiliated Hospital of Dalian Medical University has established the first cancer cardiology clinic in the national general hospital, which has been continuously developed and improved in the assessment process. in order to fully understand, we will arrange oncologists to rotate to cardiovascular department, and cardiovascular is the same. at the same time, we also introduce experts from the radiotherapy department, imaging department and clinical pharmacists to jointly evaluate and establish process channels. clinical pharmacists have unique advantages because they are familiar with the side effects of each drug, both cardiovascular drugs and tumor drugs. Their intervention provides a lot of help for the standardized diagnosis and treatment of interdisciplinary. in the outpatient department of oncology and cardiology, doctors from oncology and cardiovascular department make joint visits. At the same time, clinical pharmacists participate in the consultation. We make joint efforts to improve, so that patients can get timely care and care, and develop a comprehensive diagnosis and treatment plan to solve complex problems. looking forward to the future, it is expected to strengthen the basic and clinical research of oncocardiology, so as to provide better basis for clinical practice; to carry out multi center cooperation, carry out epidemiological investigation, establish case registration database; promote the establishment of screening and early warning mechanism for patients with tumor heart disease in various types and levels of hospitals, as well as suggestions for intervention measures; and establish oncocardiology education Through the conference, network, media and other channels, actively promote the spread of oncocardiology knowledge and prevention concept. we look forward to the cooperation of experts from various disciplines to jointly promote the development of cancer and heart disease in China, further improve the quality of life of cancer patients and improve the prognosis of patients. scan the QR code of the poster to watch the wonderful playback editor: Zhang Yuhui reviewed by: Wang Lina contribution to the doctor's daily public email: yishibao2017@163.com [note] some of the pictures are from the network and wechat circle of friends. 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