Cardio-Oncology

Cancer treatments keep getting better and better. And so do survival rates. But even though they’re effective at killing abnormal cells, cancer drugs (chemotherapy) and radiation therapy to your chest can sometimes cause lasting damage to your heart.

And it may not be right away. Sometimes, cardiotoxicity can show up years after you’ve had cancer treatment. It’s common in adults who had childhood cancer treatment. Or people at risk for, or who already have, heart disease. 

Rarely, cancer can directly invade the heart, and in such cases our team is here to help.

Reasons why you may need cardio-oncology care

When you start cancer treatment, we consider many factors as we plan your care. We’ll consider building a cardio-oncology evaluation (and treatment) into your care plan if you:

• Have risk factors for heart disease like type 2 diabetes, high blood pressure, high cholesterol, having overweight or obesity or a family history of heart disease.
• Are being treated for heart disease.
• Are having cancer treatment and feel weak or tired, have swollen legs and feet, notice chest pain or have dizziness. Or if your heartbeat races, feels too slow or skips a beat.
• Have a cardiac tumor.
• Have had past cancer treatments and show signs of heart problems.
• Have developed advanced heart failure from earlier cancer treatments.

Left undetected or untreated, cardiotoxicity can also cause an enlarged heart (cardiomyopathy) or heart valve disease. It can trigger heart attacks. And it can thicken your heart’s lining (constrictive pericarditis). If you have heart risk factors or have been diagnosed with heart disease, a cardio-oncology evaluation is an important part of your cancer treatment plan.

What to expect during your evaluation

When you come to your evaluation, your provider will spend time getting to know you. Understanding your story is an important part of this process. So, they’ll ask you questions about your overall health, your family health history and if you’ve had any problems with your heart before or during cancer treatment. You’ll want to be ready to go over what kind of symptoms you’ve had and how long you’ve had them.

During the evaluation, your provider will order tests to check your risk of getting cardiotoxicity — or spot signs of it before it starts to cause serious damage. You may have tests like:

• Echocardiogram (Echo). Checks your heartbeat and blood flow.
• Electrocardiogram (EKG). Checks your heart rhythm and can show if you’ve had a heart attack, heart failure or heart damage.
• Cardiac MRI. Creates detailed pictures of your heart from the inside. It lets us see how blood flows through your heart.
• Cardiac CT scan. Uses X-rays from different angles to create a detailed picture of your heart.
• Cardiac stress test. Helps us see how your heart reacts when it’s working hard.

We may also do cardiac blood tests to check for cardiac enzymes (cardiac biomarkers). These enzymes show up in blood samples when there’s heart damage.

Meet Our Cardio-Oncology Team

Getting care at Cleveland Clinic means you’ll have a team of expert providers from different specialties, carefully selected for your unique needs. This team works together to plan and manage your heart and cancer care for the best results. You may see:

• Cardio-oncologists.
• Cardiologists.
• Oncologists.
• Radiation oncologists.
• Radiologists.
• Electrophysiologists.
• Interventional cardiologists.
• Cardiac surgeons.

Your care team will go over your test results with you. And they’ll talk with you about your treatment options, always keeping your cancer care plan in mind. They’ll go over the risks and benefits of both cancer and heart treatment. And they’ll explain how we can try to move cancer treatment along — while addressing heart risks and problems.

We keep all of this in mind as we build your cardio-oncology care plan to focus on limiting heart damage while treating cancer. You may have:

Medications

If you’re taking any medications that could affect your heart, our team may recommend stopping them. Or they may decrease the dose or find an alternative.

They may also recommend drugs to help your heart work better, like:

• ACE inhibitors open blocked arteries so blood flows better.
• Beta-blockers increase blood flow and slow a rapid heart rate.
• Guideline-directed medical therapy (GDMT) uses four different drugs to treat you, especially if your heart isn’t pumping enough blood from its left ventricle (heart failure with reduced ejection fraction).

Our team works together (and with you) to choose the right drugs, dosage and how often you should take them.

Surgery

For a very small minority of patients that have advanced heart failure or damage from earlier cancer treatments, we may recommend heart surgery. This could include artificial heart pumps, valve repair or replacement, or even a heart transplant. Our team will go over everything you need to know about surgery before it ever happens.

Life after cancer treatment

Even after your cancer treatment ends, we keep a close eye on you. Even if you didn’t have heart problems during treatment. Why? Because cardiotoxicity can develop even several years after chemo or radiation therapy. Regular testing and follow-up visits help us catch any changes in your heart and start treatment as soon as possible.

Taking the Next Step

You have a lot on your mind when you go through cancer treatment. So, when you find out these treatments may be causing problems with your heart, it may feel a little unsettling. We make sure you understand what’s going on and how your heart care will coexist with your cancer treatment. And if you know you’re at risk before you start treatment, we’re here to help you avoid damage as much as we can. You can count on our expert cardio-oncology team to be there for you — before, during and after cancer treatment.