Based on the newest official epidemiological data from the federal statistical office (Statistisches Bundesamt), most people in Germany die from cardiovascular disease (38.5%). The second most cause of death is any kind of neoplasia (25%).1 This distribution is more or less stable throughout the last years. Based on this simple observation and comparable to epidemiological data from other European countries, it became obvious that both patient cohorts, patients with cancer and cardiac patients share overlaps.
These overlaps are related to risk factors such as diabetes, smoking, obesity, and age but also to their specific comorbidities. Moreover, there is a growing evidence for a direct links between cancer, cancer therapies and cardiac events and vice versa.
Based on data from the Robert Koch Institute the cancer entity with the highest incidence in Germany is the mamma carcinoma. Therefore, anthracycline and HER2 antagonists induced cardiotoxic effects might be statistically the most common side effects and cardio-oncological cases. However, there is no established, national wide registry available that records patients with anthracycline induced cardiotoxicity.
Based on the recent progress in cancer therapeutics (e.g. proteasome inhibitors, ras/raf/mek inhibitors, checkpoint inhibitors) an increase in patients, treated with novel cardiotoxic therapies can be expected.
The department of cardiology at the university hospital of Heidelberg established the first specific cardio-oncology unit in 2014 in close cooperation with the National Center for Tumor Diseases Heidelberg (NCT). Other university hospital have also established cardio-oncology units in the following years (e.g. Essen, Kiel).
Based on an initiative from Heidelberg and Essen a specific working group for cardio-oncology (AG 40) in the German society of cardiology (DGK) was established in 2018. Other university hospitals, such as Berlin, Köln, Göttingen, Hannover, Kiel and Mannheim have also initialized or plan to initialize a cardio-oncology unit and they are also part of the working group in the German society of cardiology.
Many of the cancer therapies in Germany are done in outpatient settings. Therefore, a cardiovascular monitoring is done by practitioners or in standard care and advanced care hospitals. Based on the members of the working group for cardio-oncology within the DGK, many of the specific cardio-oncologies are currently established in standard care and advanced care hospitals. The working group for cardio-oncology aims to integrate this experience with academic and scientific question, to move the whole field forward.
In parallel to the initiatives in the cardiac society, a working group was also initialized within the German society for hematology and oncology (DGHO) to share expertise and to build up the basis for combined sessions on the congresses of these two societies on a yearly basis.
The initiatives within the DGK and the DGHO aim to standardize the procedures and to bring together basic and clinical researchers.
Current recommendation for the treatment and observation of cancer patients with cardiotoxic events and/or cardiotoxic therapies in Germany are based on the DGK-comment on the ESC position paper.2
Authors
Dr. med. Lorenz Lehmann
Universitätsklinkum Heidelberg
Abteilung für Kardiologie, Angiologie und Pneumologie
Kardio-Onkologische Ambulanz
Im Neuenheimer Feld 410
69120 Heidelberg
Univ.-Prof. Dr. med. T. Rassaf
Universitätsklinikum Essen (AöR)
Westdeutsches Herz- und Gefäßzentrum Essen
Klinik für Kardiologie und Angiologie
Hufelandstr. 55
45147 Essen
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