Owing to the increasing success of cancer treatment, it is probable that more long-term-surviving patients will develop heart disease later in life. The occurrence of simultaneous cancer and cardiovascular disease will also become more common due to increasing age, obesity and presence of other shared risk factors (Box 1). Most series, in which these patients are studied, have a retrospective nature, are of different study design, have a short follow-up time and are of small size. Moreover, some comparative results are invalid because of different basic characteristics of patient groups. This makes pooling of data or even simple comparison of results difficult. These studies only generate hypotheses and do not offer any proof of superiority of any procedure (one-stage vs two-stage procedure; CABG with vs without ECC). Nevertheless, some principles can be derived from the available results:
The treatment of a severe or unstable heart condition in patients with simultaneous disease has priority because of its life-threatening nature;
Simultaneous surgical treatment of heart disease and cancer is often safe and feasible, but the effect of the use of ECC on cancer dissemination or on postoperative survival is still unclear;
If treatment by PCI is needed, the use of DES should be avoided because of the need for DAPT, 1 year after the implantation. This causes a delay for cancer surgery, which is unacceptable from an oncologic viewpoint. Although the treatment of heart disease has priority because of its life-saving aspect, the long-term postoperative survival in patients with simultaneous disease is largely determined by the stage of the tumor;
In patients with previously treated malignancy, the postoperative survival is determined by the time interval between the treatment of the tumor and heart surgery. With a longer time interval, the chance of cure of the cancer is higher.