Cardiovascular impacts of combination cancer therapies in Africa: challenges and solutions

Abstract

BACKGROUND: In Africa, deaths from non-infectious causes, including cancer, have been rising. In 2022, over a million new cancer cases were reported, and projections indicate that this number could double by 2040 without significant interventions. To improve cancer management, combination treatments often including systemic therapies, radiotherapy, and surgery are employed, however, they pose the risk of cardiotoxicity. Given the growing burden of cancer and the associated cardiovascular complications, it is essential to evaluate the cardiovascular outcomes of combination cancer therapies in African populations, identify challenges faced by healthcare systems, and propose strategies to mitigate these risks. MAIN BODY: Several anti-cancer agents, including anthracyclines, HER2 inhibitors, immune checkpoint inhibitor myocarditis, VEGF inhibitors, 5-fluorouracil, etc., have been linked to cardiovascular complications. These include left ventricular dysfunction, immune myocarditis, coronary spasms, and oxidative stress-induced cardiomyocyte death amongst others. The field of cardio-oncology has emerged to address these risks and improve patient outcomes. African health systems face unique challenges in managing cardiovascular risks associated with cancer therapies. These include delayed diagnosis and limited screening, resource constraints, underrepresentation in clinical trials, comorbidities, and socioeconomic barriers. These factors hinder early detection and management of cardiovascular complications, exacerbating the burden of treatment-related morbidity and mortality. CONCLUSION: As the burden of cancer continues to rise in Africa, addressing cardiovascular complications associated with cancer therapies is critical. Strengthening cardio-oncology programs, improving early screening, and increasing access to cardiovascular care within oncology settings are essential steps toward better patient outcomes. By addressing existing gaps and resource limitations, African healthcare systems can enhance cancer treatment while minimizing the attending cardiovascular risks.