Advances in cancer treatment over the past 30 years have led to increased cancer survival and larger numbers of people living cancer-free for many years after treatment.
These life-saving treatments, while successful at treating cancer, can sometimes cause problems in the heart and vascular (circulation) system - called cardiotoxicity.
Cardiotoxicity can develop during cancer treatment - or - can occur within days or months or years after cancer treatment, once patients are cancer-free. Heart damage caused by chemotherapy-induced cardiotoxicity can reduce quality of life and increase the risk of death from cardiac-related causes.
Do all types of cancer treatment can cause cardiotoxicity?
No. Not all types of cancer treatment can cause cardiotoxicity, but many have the potential for causing cardiac damage, including:
- Chemotherapy with certain drugs
- Radiation therapy to the chest area
- Targeted therapy (molecular therapy)
- Monoclonal antibodies
- Drugs used to prevent cancer recurrence
What types of heart problems can be caused by cancer treatments?
Cancer treatment can cause the heart to pump less efficiently, cause changes in blood flow and/or increase the risk for blood clots (thrombosis) that can cause heart attack.
The most common heart conditions caused by these changes are congestive heart failure – the most serious cardiotoxicity related to cancer treatment – inflammation of the heart muscle (pericarditis) and coronary artery disease. Other heart problems that can be caused by cancer treatment include low blood pressure (hypotension), high blood pressure (hypertension), abnormal heart rhythm (arrhythmia) and valve disease.
Management and Treatment
Strain imaging performed during and after cancer treatment can detect small changes in the heart’s size, rhythm or pumping ability. These small changes may be early signs of cardiotoxicity and signal the need for potentially cardioprotective medications and occasionally suggest the need for a change in medication for chemotherapy.
What is Cardio-Oncology?
Patient’s whose cancer treatment involves an increased heart risk, or those who have a history of heart disease should choose a cancer care team that includes a cardiologist who works closely with the cancer doctors to monitor the patient’s heart health before, during and after treatment. For this reason, the Cleveland Clinic Cardio-Oncology Center provides patients with a multi-disciplinary approach aimed at lessening risks and improving outcomes for patients. If a patient starts to develop signs of cardiotoxicity during treatment, the cardiologist may treat the cardiotoxicity preventing the need to interrupt cancer treatment. In addition, the cancer doctor may alter the patient’s treatment plan to provide a less toxic dose.
Who is at risk for cardiotoxicity?
In general, patients with existing heart disease at the time they start cancer treatment and those with risk factors for heart disease may be at highest risk. Heart disease risk factors include:
- Cigarette smoking
- High fat diet
- Inactive lifestyle
- Family history of heart disease
Some chemotherapy drugs affect the heart muscle and the blood vessels, so patients on these drugs have a higher risk for cardiotoxicity, especially if they have underlying heart risk factors. Patients who receive radiation therapy to the chest may be at risk because of the proximity of the heart to the radiation field.
How can cardiotoxicity be prevented?
Before treatment it is important to ask yourself 2 questions:
- Do you have a history of heart disease?
- Do you have risk factors for heart disease?
Next, ask your doctor the following 3 questions:
- Does my treatment plan put me at risk for future heart damage (is it cardio-toxic)?
- Do you do use special testing to screen for heart problems before, during and after treatment?
- Will my treatment involve radiation treatment to the chest?
Cancer patients who are to receive potentially cardiotoxic therapy should have a complete physical and cardiac evaluation before starting cancer treatment. This evaluation can help the doctors identify patients who are at risk for cardiotoxicity and take measures to minimize the patient’s risk . It should include:
- Personal medical history
- Family medical history
- Thorough cardiovascular physical examination
- Tests of heart function including echocardiography and measurement of global strain
Global strain is a new measurement of how the heart muscle functions and is determined by echocardiography with specialized computer technology. It allows for a more accurate assessment of changes to heart function due to potentially cardiotoxic treatments.
Outlook / Prognosis
Are the changes to the heart permanent?
How long these changes last is still uncertain. Some changes appear to be reversible, while other damage seems to be permanent.
What steps can a cancer patient take?
If you need to undergo cancer treatment, you can take a proactive role in avoiding cardiotoxicity.
- Tell your doctor about any personal or family history of heart disease.
- Ask your doctor if your cancer treatment poses any risk to your heart and blood vessels. If the answer is yes, talk to your doctor about having a complete heart evaluation before, during and after treatment.
- Know the types and doses of all drugs and radiation that will be or were used to treat your cancer- keep careful notes.
- Quit smoking, eat healthy and exercise.
- Avoid alcohol or caffeine during cancer treatment. They can cause palpitations and increase heart rate.
- Tell your doctor about any chest pain, shortness of breath, heart palpitations or swelling in your legs or feet that you experience.
- Do not ascribe all your symptoms to “normal” side-effects of cancer treatment.
What does the future hold?
As cancer survival rates continue to increase, knowledge about cardiotoxicity related to cancer treatment is growing. Researchers are working to learn more about what causes cardiotoxicity and how it can be detected, treated and – most importantly – prevented.
The Cardio-Oncology Center is a specialized center involving a multi-disciplinary group of specialists, including cardiologists, oncologists, cardiac surgeons and nurses from the Miller Family Heart, Vascular & Thoracic Institute and The Taussig Cancer Center who provide a comprehensive approach to evaluating, diagnosing and treating cardiotoxicity.
If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
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