Cardiotoxicity is a leading cause of mortality in the growing populations of elderly breast cancer (BC) patients. Breast cancer treatment in the elderly is highly challenging due to its heterogeneous nature and the lack of specific evidence, as this population is usually underrepresented in randomized clinical trials. Decision making requires a comprehensive approach, considering the type and stage of BC, the patient’s overall health status, life expectancy, geriatric and frailty assessment, the risk of cancer recurrence, comorbidities, cardiotoxicity risk, and the patient’s preferences. The cardiotoxic effects of BC treatments cover the whole spectrum of cardiovascular diseases: heart failure, hypertension, arrhythmias, and myocardial ischemia. Cardiotoxicity risk in these patients is defined by several factors: anticancer therapies, polypharmacy, established cardiovascular disease, comorbidities, frailty, cellular senescence, hormonal changes, and genetic predisposition. Preventive oncological and cardio-oncological strategies, as well as patients’ education, are critical for improved outcomes. Prospective clinical trials in this population are urgently needed.
心脏毒性是日益增长的老年乳腺癌患者群体中主要的致死原因。由于老年乳腺癌的异质性及缺乏特异性证据，其治疗极具挑战性，因为该人群在随机临床试验中的代表性通常不足。临床决策需要采取综合评估方法，需考虑乳腺癌的类型与分期、患者的整体健康状况、预期寿命、老年综合评估与衰弱状态、癌症复发风险、合并症、心脏毒性风险以及患者个人意愿。乳腺癌治疗的心脏毒性效应涵盖各类心血管疾病：心力衰竭、高血压、心律失常和心肌缺血。此类患者的心脏毒性风险由多重因素决定：抗癌治疗方案、多重用药、既存心血管疾病、合并症、衰弱状态、细胞衰老、激素变化及遗传易感性。预防性肿瘤学和心脏肿瘤学策略以及患者教育对改善预后至关重要。当前亟需针对该人群开展前瞻性临床试验。
肿瘤(癌症)患者之家