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Cancer and the Heart

As cancer therapies become more successful, more patients survive and live long lives. While this is very positive, we must stay aware of the fact that patients can develop heart problems during and after cancer treatment. This effect is called cardiotoxicity.

Breast cancer

This condition may present as high blood pressure, inflammation in the heart, heart valve problems, abnormal heart rhythms, damaged blood vessels, narrowed arteries, blood clots and, ultimately, heart failure.

Prominent symptoms of heart failure include shortness of breath, fatigue with normal physical activity, and swelling in your legs. Yet these can result from other causes, including cancer and treatment side effects. That’s why it’s important that your heart is monitored throughout cancer treatment, often through the use of echocardiograms and MRI.

Why does this happen?

Chemotherapy is very effective at destroying cancer cells. This also means it can damage healthy cells, including those in the heart. We know that certain cancer treatments can be toxic to the heart, including:

  • Anthracyclines: Daunorubicin, Doxorubicin, Epirubicin, Idarubicin, Mitoxantrone
  • Biologics (HER2-targeted therapies): Trastuzumab, PertuzumabT-DM1, Lapatinib
  • Antimicrotubule agents: Paclitaxel, Docetaxel

For example, breast cancer interventions include surgery, chemotherapy, radiation and hormonal therapy. One in five people will have “HER2-positive breast cancer” marked by high levels of a particular. For them, treatments such as trastuzumab (Herceptin) are used to target HER2. It is standard of care that clinicians assess these patients’ heart function every three months during treatment – because of the therapy’s cardiotoxic nature.

leukemia cells
mammogram

The ideal treatment team

Oncology and cardiology teams should work together – as they do in our cardiotoxicity prevention program – to help prevent any heart problems during cancer treatment.

“Cardio-oncologists” are cardiologists who assess cancer patients before treatment, monitor their symptoms and heart function during treatment, and provide long-term follow-up after treatment.

A key goal is to minimize interruptions to cancer therapy, as delays influence long-term outcomes. Where necessary, your cardio-oncologist can start medications to stabilize and improve heart function while the oncology team continues to administer cancer therapy.

Role of the patient

Patients should be empowered to self-monitor and self-manage their symptoms as part of cardiotoxicity prevention.

After the cancer therapy has finished, it’s important to stay to stay healthy and decrease any risk of heart damage. Tips include:

  • Follow up with your doctor: Keep routine checkups on an ongoing basis to keep cancer at bay and your heart functioning well.
  • Stay physically active: Exercise reduces the risk of heart disease. Aim for at least 30 minutes a day of moderately intense exercise.
  • Eat well: Nutritious food lowers the risk of cancer, heart disease, and a host of other health problems. Diets to mimic include the Mediterranean and DASH approaches.
healthy eating
exercise
  • Manage stress: It’s very stressful to undergo cancer treatment. In its wake, do your best to manage stress via support groups, talking with family, friends and your doctor, and finding relaxing activities.
  • Sleep well: While not necessarily in our full control, healthy sleeping habits are important for your heart health and overall well-being.
  • Listen to your body: If you are worried about any symptoms, do not hesitate to call your doctor.
  • Follow your treatment plan: This is essential for your health-care team to determine if the treatment is working as intended or if it must be adjusted.