As more people are surviving cancer than ever before, greater attention is being focused on the cardiotoxicity of therapies and their long-term effects on the heart.
“There’s a lot we can do to prevent and manage heart disease, no matter what your cancer treatment history is,” says Jenica Upshaw, MD, a cardio-oncologist at Beth-Israel Deaconess Medical Center (BIDMC).
Cardio-oncologists work together with medical oncologists to determine the best way to maintain heart health and manage heart disease in patients with cancer.
What is cardio-oncology?
Cardio-oncology is the care of cardiac concerns in patients with cancer, whether those cardiac concerns developed before, during or after treatment for cancer. Dana-Farber’s cardio-oncology service is offered through the Adult Survivorship Program.
What symptoms might suggest I have a cardiac concern?
Talk to your primary care physician or oncologist if you experience shortness of breath, trouble breathing, chest pain, or a racing heartbeat. A cardiac evaluation can help determine if there is any evidence of heart disease.
When is a cardio-oncology consult needed?
Your oncologist will determine if a cardio-oncology referral is needed. The need for a referral depends on your personal history of heart disease, your current health, and your cancer treatment – be it past, ongoing, or about to begin.
“Our goal is to respond to every referral in a timely manner and make sure our patients get the help they need,” says Alicia Morgans, MD, MPH, a medical oncologist and director of Dana-Farber’s Adult Survivorship Program. “We understand that a cancer diagnosis is stressful, so we want our patients to know they are supported in every way possible.”
What happens once I am referred to a cardio-oncology consult?
The Dana-Farber cardio-oncology service holds multiple clinics at Dana-Farber each week. Those clinics are staffed by cardiologists who are contracted by Dana-Farber. Patients can also be evaluated elsewhere by a physician of their choosing.
The cardiologist may order or perform diagnostic tests, such as an echocardiogram (an ultrasound of the heart), or an EKG (a measure of the electrical activity in the heart). These and other diagnostics will help your care team determine how best to support you and your cancer care.
What cancer medicines affect the heart?
Some medicines used to treat cancer can affect the heart. For example, chemotherapy drugs known as anthracyclines (such as doxorubicin), trastuzumab (Herceptin), and ibrutinib can affect the heart. Some targeted medicines can increase the risk of high blood pressure. Immune checkpoint inhibitors may also increase the risk of inflammation of the heart muscle.
Oncologists and cardio-oncologists are familiar with these risks and have strategies for reducing risk and monitoring heart health.
What can be done to reduce the risk of cardiovascular problems related to cancer treatment?
One strategy is to avoid “cardiotoxic” for patients with heart disease or cardiac risk factors if other medicines can be used instead without compromising patient outcomes.
When alternative medicines cannot be safely used, guidelines suggest that oncologists take steps to minimize the heart’s exposure to certain drugs or radiation. One strategy is to use lower doses of cancer drugs and to combine these treatments with medications to help protect the heart. Radiation therapy can also be modified to protect the heart.
“We work closely with a patient’s oncologist to help determine the best cancer treatment strategies and coordination of care,” says Upshaw.
Is follow-up monitoring for heart concerns after treatment important?
Depending on the treatment you received for cancer and your existing cardiac health, you may be monitored before treatment starts and after treatment ends to determine if cardiac damage has occurred.
“If you catch these problems early, you may be able to delay the onset of serious symptoms or even reverse the damage by giving drugs like beta blockers or ACE inhibitors,” Morgans says.
Is there anything I can do to reduce the risk of cardiovascular problems?
Upshaw recommends prioritizing heart health throughout your lifetime. A few things you can do include:
- Don’t start smoking, or look into ways to reduce or stop smoking if you’ve already started;
- Be aware of and take steps to manage risk factors like obesity, diabetes, high cholesterol and high blood pressure;
- Focus on maintaining a healthy diet and lifestyle. Exercise, including walking, for at least 150 minutes a week can help reduce your risk of heart disease.
“Maintaining heart health not only reduces the risk of heart disease but also could reduce the risk of some cancers,” says Upshaw.
It’s tough to see and read what cancer patients go through, and then to follow that up with heart problems! Stay strong!