Littérature scientifique sur le sujet « Cardioncologia »

Cancer is the leading cause of morbidity and mortality in the United States and globally. Owing to improved early diagnosis and advances in oncological therapeutic options, the number of cancer survivors has steadily increased. Such efficient cancer therapies have also lead to alarming increase in cardiovascular complications in a significant proportion of cancer survivors, due to adverse cardiovascular effects such as cardiotoxicity, cardiac atrophy, and myocarditis. This has emerged as a notable concern in healthcare and given rise to the new field of cardioncology, which aims at understanding the processes that occur in the two distinct disorders and how they interact to influence the progression of each other. A key player in both cancer and heart failure is the genome, which is predominantly transcribed to noncoding RNAs (ncRNAs). Since the emergence of ncRNAs as master regulators of gene expression, several reports have shown the relevance of ncRNAs in cancer and cardiovascular disorders. However, the knowledge is quite limited regarding the relevance of ncRNAs in cardioncology. The objective of this review is to summarize the current knowledge of ncRNAs in the context of cardioncology. Furthermore, the therapeutic strategies as well as the prospective translational applications of these ncRNA molecules to the clinics are also discussed.

La cardio-oncologia, disciplina finalizzata alla diagnosi, alla prevenzione e/o al trattamento delle complicanze cardiovascolari (aritmie, disfunzioni contrattili, ischemia o disturbi pressori, ma anche di eventi emocoagulativi) delle terapie antitumorali, è in continua espansione in considerazione della disponibilità crescente dei trattamenti antitumorali e dell’aumento, anche in Italia, del numero di casi prevalenti (numero di persone vive dopo una diagnosi di tumore), pari a circa 3 milioni stimati per il 2015, con un incremento del 17% rispetto al 2010 (+20% per i maschi e +15% per le femmine). A tale proposito si è reso sempre più indispensabile sviluppare questo campo di applicazione con competenze specialistiche integrate, al fine di comprendere a fondo i meccanismi della cardiotossicità, fornire definizioni uniformi e condivise degli effetti dei farmaci oncologici su cuore e vasi, identificare dei percorsi di diagnosi e trattamento del paziente oncologico prima, durante e dopo le terapie antitumorali e proporre modelli organizzativi efficienti e sostenibili. Di particolare interesse clinico-amministrativo sono infine la strutturazione della consulenza cardio-oncologia e l’organizzazione dell’ambulatorio di cardio-oncologia.
Life expectancy in patients affected by cancer has recently increased because of early diagnosis and actual therapies. In recent years, Oncology and Cardiology developed a tight relationship because of common risk factors (i.e. obesity, smoking, alcool intake, etc...), and for preventing the pro-thrombotic status due to cancer and the potential cardiotoxicity of chemotherapy. Cardiotoxicity incidence is reported from 1% up to 70% in retrospective analyses of drug protocols, mainly representing by left ventricular dysfunction (both reversible or irreversible), but also by arrhythmias, hypertension, atrioventricular block, coronary spasm, and arterial or venous thromboembolism. The early detection of the chemoterapy induced cardiotoxicity is now mandatory and can be obtained through a proper patients selection for different treatments and a strict monitoring during the follow-up period. The role of biomarkers of early cardiac damage, mainly, troponin I and brain natriuretic peptide-BNP, has been recently challenged, and algorithms are currently available.

Cardiotoxicity caused by cancer therapy can be monitored using LVEF assessment. This dissertation aims to develop a cost-benefit model to analyze a LVEF assessment using a healthcare payer perspective and five, ten and thirty years time horizon. A Markov model, informed by the retrospective clinical course of 109 patients followed by Hospital de Santa Maria, Portugal on transitional probabilities, was built to assess the cost-benefit of LVEF assessment. Costs and utilities were assessed over a 5, 10 and 30-year range, with sensitivity analyses for significant variables. In the reference cases of a 50 years old and 60 years old patients treated in LVEF assessment, the 5-year time horizon (4.23 QALYS and €5,824 cost over 5 years) and (3.79 QALYs and €13,657 cost over 5 years), respectively dominated the 10 and 30-year time horizon. Under a time horizon of 5 years at a Willingness to Pay threshold of €375.000, over 53,6% and 50,3% of simulation adds QALYs above average for patients starting treatment with 50 and 60 years old, respectively. Monte Carlo simulation of the Markov model had no effect on model conclusions. From a Portuguese health payer perspective, the analysis of cost-benefit in cardiotoxicity suggest that the costs per QALY increase substantially with the time horizon and with the starting age. Also, the probability of additional QALY relatively to the average QALY of the hypothetical cohort of 1000 patients at Willingness to pay decreases with the increase of the time horizon and with the starting age.
Cardiotoxicidade é um efeito adverso da terapêutica do cancro e pode ser monitorizada através da avaliação da LVEF. Nesta dissertação desenvolveu-se um modelo de custo-benefício para analisar a LVEF na perspetiva do recetor de cuidados de saúde e num período de 5, 10 e 30 anos. O modelo Markov, assente na progressão clínica retrospetiva de 109 pacientes seguidos no Hospital de Santa Maria, Portugal e probabilidades de transição, foi desenvolvido para medir o custo-benefício da análise LVEF. Custos e utilidades foram monitorizados num período de 5, 10 e 30 anos, e foi elaborada uma análise de sensibilidade para as variáveis significativas. Nos casos de referência de pacientes com 50 e 60 anos avaliados na monitorização da LVEF, o período de análise de 5 anos (4.23 QALYs e custo de €5,824) e (3.79 QALYs e custo de €13,657) respetivamente, destacou-se dos períodos de 10 e 30 anos. Durante o período de 5 anos e disposição a pagar de €375.000, a probabilidade de um QALY adicional em relação à média aumenta 53,6% e 50,3% para pacientes de 50 e 60 anos, respetivamente. A simulação Monte Carlo do modelo Markov não teve efeito sobre as conclusões do modelo. Para Portugal, a análise de custo-benefício sugere que os custos por QALY aumentam substancialmente com o período de análise e a idade. Adicionalmente, a probabilidade de um QALY adicional em relação à média na disposição a pagar de uma coorte hipotética de 1000 pacientes decresce com o aumento do período de análise e a idade.