Aims: Cancer patients are at high risk of cardiovascular disease (CVD) due to shared risk factors and treatment effects. This umbrella review aimed to explore current evidence supporting interventions to manage CVD risk in cancer, to inform a nurse-led model of care.
Methods: An umbrella review was conducted adhering to PRISMA guidelines, via a broad search of 6 databases (MEDLINE, Embase, CINAHL, Web of Science, SCOPUS, Cochrane Library) using search terms related to cancer, cardiovascular disease, and health care delivery/models of care. Titles/abstracts and full texts were screened for systematic reviews and meta-analyses of interventions to manage CVD in adults with cancer. Data on objectives, participant characteristics, intervention/model of care characteristics, outcomes, and conclusions were extracted by two reviewers, with conflicts resolved by a third reviewer. Quality appraisal was performed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Systematic Reviews and Meta-analyses.
Results: Of a total 3522 deduplicated records, 508 were retained for full-text screening. Of these, 14 systematic reviews and meta-analyses were included for data extraction. JBI Critical Appraisal scores ranged from 6 to 11 (max. 11). Interventions included cardio-protectant pharmaceuticals (6 reviews), monitoring and screening techniques (6 reviews), exercise interventions (2 reviews) and use of Coenzyme Q10 (1 review). Pharmaceutical evidence was most consistent for dexrazoxane cardioprotection. Some evidence was found for use of cardiac stress testing, diastolic parameters, and biomarkers, particularly troponins, in predicting/managing cardiotoxicity. Exercise interventions were deemed safe and potentially effective, but reviews noted the need for more evidence on cardiac function effects and appropriate prescriptions. Evidence for Coenzyme 10 was inconclusive. Reviews gave minimal detail on how or by whom interventions were implemented.
Conclusions: There is a paucity of high-quality evidence on interventions to manage CVD risk in people with cancer and their implementation, with further research in this area needed.