Understanding Heart Problems After Cancer Treatment

Sadberg feels good after finishing his first Half Ironman Triathlon in September 2013. Seven years ago, at the age of 20, Burke was receiving chemotherapy and radiation to relieve stage 2 Hodgkin lymphoma. Burke, a resident of Brandon, Mississippi, had cancer behind him and was at his highest fitness level. As a result, Burke was stunned when regular annual cancer survivor tests showed heart problems within four months of the race.

“When I go to these tests, there is always a risk of cancer recurrence. But my mid-twenties heart disease wasn’t on my radar. I had no symptoms and was more physically active than ever.” Says Burke. “I was aware that cancer treatment could affect my heart in the future, but I didn’t know how fast it could go.”

The compression effect, known as the ejection fraction of Burke’s left ventricle, was low. His heart pumped 45% of the blood volume with each compression. According to the American Heart Association, healthy ejection fractions for men usually range from 55% to 70%. Less than 40% indicate some degree of heart failure. Burke echocardiographic readings showed diminished cardiac function. He had no overt heart failure, but there were clear changes in his myocardium. If left untreated, the injury can lead to actual heart failure.

Connecting cancer and heart disease

Doctors have long known about cardiotoxicity, the toxic effects of certain cancer treatments on the heart. Chemotherapy, for example, is effective because it kills cancer cells. However, the drug also affects healthy cells, including those that power the heart. Herceptin (trastuzumab), anthracyclines and 5-fluorouracil have the strongest cardiotoxic effects. Radiation therapy, especially treatments that target tumors in the chest, can damage the heart muscle and affect the coronary arteries that supply the heart muscle with blood and oxygen. Studies also show a link between specific targeted therapies, hormonal therapies, immunotherapy, and heart problems. However, in addition to direct damage to the heart and related tissues, most heart problems in cancer patients are the result of secondary effects of the drug on blood pressure, lipids, sugar control, and lifestyle changes. Cardiovascular disease is not just for cancer survivors.

According to the US Centers for Disease Control and Prevention, one in four Americans is killed each year and is a major cause of adult death.

The term “cardiovascular disease” can be life-threatening, including coronary or heart disease (often caused by arterial plaque accumulation), heart attack, heart failure, valve disease, aneurysms, stroke and arrhythmias. Includes a series of problems. Survivors of cancer are also more likely to develop pericarditis, an inflammation of the sac that surrounds the heart.

Survivors also face the challenge of treating cardiovascular disease. “People who receive radiation therapy to the chest can develop fibrosis. This hardened, wounded tissue can make it more difficult for cardiovascular surgeons to perform the procedure. [such as] “Coronary artery bypass grafting or heart valve replacement,” said Dr. Daniel A. Marlouney, deputy director of the clinic after treatment at St. Jude Children’s Research Hospital in Memphis, Tennessee.

According to the American Heart Association, almost half of Americans have some form of cardiovascular disease, and millions more are at high risk of developing it. Well-known causes of heart disease include high blood pressure, high cholesterol, diabetes, overweight, family history, smoking, and a sedentary lifestyle. However, despite studies showing that people who receive certain cancer treatments are more likely to develop serious heart problems at a younger age than most people, cancer and its treatment It is rarely mentioned as a risk factor. The outcome of cancer survivors is even worse, according to the European Society of Cardiology. You are up to 6 times more likely to die of cardiovascular disease than someone who has never had cancer.

“Cancer screening has increased the number of cancers diagnosed, including many cancers that were once overlooked. Early-stage breast cancer, in which more people respond favorably to treatment, We have been diagnosed with low-risk cancers such as prostate, thyroid, and kidney cancer, if treatment is needed, “said Dr. Nicholas Zaorsky, assistant professor at the ministry. Radiation Oncology at the Pennsylvania Cancer Institute in Hershey, Pennsylvania. “Many cancer survivors live longer and are more likely to die from other competing causes, such as cardiovascular disease, rather than the cancer itself.”

Zaorsky is part of a research group that conducted one of the largest and most comprehensive observational studies investigating the deaths of cancer survivors from cardiovascular disease. The study examined the causes of death in people with 28 types of cancer during the 40 years from 1973 to 2012. One in ten cancer survivors die of the cardiovascular system, according to a study published in the December 2019 issue of the European Heart Journal. Illness, not cancer. People who are diagnosed with all types of cancer before the age of 55 are 10 times more likely to die of a variety of cardiovascular problems than people without cancer. This risk was highest among people with cancer of the bladder, larynx, prostate, uterus, colon, or breast.

Still, it is the treatment, not the type of cancer, that makes heart and blood vessel problems more likely. “Cancer treatments can raise blood pressure and blood sugar levels. They can harden the heart valves and arteries. They cause weight gain, malaise, physical activity and health. It can make it difficult to maintain a good weight, “says Dr. Bonnie Key, director of the Penn Cardiac Oncology Translation Center of Excellence at the University of Pennsylvania Hospital. Philadelphia.

Over the last 15 years, cardiac oncology has emerged as a new medical specialty. Cardiologists such as Ky work with oncologists and hematologists to minimize the impact of cancer treatment on the heart during and after treatment.

“Unfortunately, adults may already have heart disease or risk factors for heart disease when they are diagnosed with cancer,” says Ky. “Cancer treatment hastens the onset of heart problems and symptoms and can cause heart damage faster than we might expect.”

Children with cancer tend to have a healthy heart. “Because of the young age at the time of initial cancer diagnosis and treatment, survivors of childhood cancer have lived longer before them,” says Mulrooney. “The risk of heart disease increases with age, but this risk, especially the chance of dying from heart disease, can increase when childhood cancer survivors become adults. This possibility is something we are still studying. “

Fortunately, many of the treatments used today are less cardiotoxic than they were decades ago. “Radiation therapy in 2020 is more focused than radiation therapy in the 1950s,” says Mulrooney. “You can more accurately target only the tumor and protect more of the surrounding healthy tissue and cells.”

As new treatments enter the market and experts learn more about the long-term effects of cancer treatment on the heart, doctors continue to make changes to protect the heart health of cancer patients. Research results published in the Journal of Clinical Oncology show that since 2005, the most cardiotoxic anthracyclines among the most commonly used chemotherapeutic agents for the treatment of breast cancer have steadily become unsupported. Doctors are now looking at taxane chemotherapeutic agents such as taxol (paclitaxel) that do not appear to cause heart damage.

The longer a cancer survivor lives, the more likely he or she will develop some form of cardiovascular disease. A study by the European Heart Journal found that cardiovascular deaths are most likely to occur in the first year after a diagnosis of cancer. “Some people develop blood clots that cause life-threatening heart attacks and strokes,” says Zaorsky. “For others, their health

They may have already been poor when they were diagnosed with cancer, and the treatment turns out to be too toxic. “

Not all people with cancer develop heart problems. However, given that so many Americans already have cardiovascular disease or its risk factors, that possibility is not in the favor of most. Fortunately, you can take steps to maintain a healthy heart.

Protection of the heart after cancer

Early detection and treatment of cardiovascular disease is the key to preventing further life-threatening problems. For some people, such as Burke, taking daily pills can help control heart disease. Burke takes carvedilol, a beta-blocker that relaxes blood vessels, improves blood flow, and lowers blood pressure. “Heart problems do not affect my ability to enjoy life,” he says. “I don’t sometimes call it a heart problem because I can do what I want with the pill.”

Cancer survivor Renita Michael developed an arrhythmia two years after undergoing stage 3 thyroid cancer surgery and isotropic radiation therapy. “I fainted at work. When I met the doctor, he said my heart was beating too fast,” she says. Michael, a resident of Hillsboro, NJ, was 38 at the time of the 2008 heart diagnosis. When the drug didn’t work, Michael performed heart ablation to restore the heart to a healthy rhythm. She is currently volunteering with the Cancer Hope Network to guide people with new diagnoses of thyroid cancer. “I tell you to check your heart regularly, especially during the first few years after treatment,” she says.

According to research results published in the BMJ, the risk of heart problems associated with cancer treatment may persist for 20 to 45 years after treatment is finished. There is time for problems to occur, but there is also time to prevent them or at least start intervention early. “Risk mitigation is the main focus of many cardiooncology studies,” said Ky, editor-in-chief of the American College of Cardiology scientific journal JACC: Cardio Oncology.

“We know that cancer survivors are prone to high blood pressure, obesity, diabetes and cause heart disease. Preventing these problems and ensuring better disease management If possible, we can improve the quality and quantity of life. “

Currently, there are no medical guidelines for cancer survivors who need to see a cardiologist or who need to undergo a specific heart test, such as an echocardiography that captures Burke’s heart problems. Recently, more and more cancer centers are running cardiovascular programs that provide continuous monitoring of heart disease, but not everyone has access to these services. The first step in protecting the heart begins with sharing a record of cancer treatment or a survival care plan with a primary care physician. Make sure the information is part of your medical record. “Often, the most appropriate management of heart care depends on the treatment received, such as lifelong exposure to drugs and radiation,” says Ky. She encourages you to learn everything you can about your cancer treatment, especially its potential heart effects. “You need to be knowledgeable and defend yourself,” she says.

Cancer survivors may also need to pay attention to important numbers such as blood pressure, blood sugar, cholesterol, and weight. Seek medical attention if you have symptoms of heart problems such as fatigue, shortness of breath, persistent coughing, swelling of the legs, palpitation, heartbeat, or decreased physical activity. As Ky points out, “We believe that cardiotoxicity is a detectable, treatable, preventable, and manageable problem.” For more information on cancer treatment and heart health, see US Heart Visit CardioSmart of the Society of Diseases. cardiosmart.org..