Certain cancer therapies can increase your risk for heart failure. Here’s what you need to know.
Getting a cancer diagnosis is hard enough. And when you learn that certain cancer treatments may increase your risk of other serious health conditions, you may worry whether the cancer treatment is worth those additional risks.
Radiation therapies and chemotherapy can increase patients’ risk of developing cardiovascular problems, but it’s also important to know that these cancer treatments also increase your odds of surviving cancer.
“It’s important for us to understand as doctors and as patients, that there can be risks associated with these therapies,” says Michelle Weisfelner Bloom, MD, cardiologist at Stony Brook University Medical Center. “My job is to [put you] in a position where you’re as safe as possible to undergo the therapy so you can beat the cancer.”
How Cancer Therapies Affect the Heart
Radiation therapy and chemotherapy can increase a patient’s risk of heart failure, heart rhythm abnormalities, and heart attack. That’s because radiation and certain cancer drugs, such as antineoplastic and anthracycline chemotherapy agents, can damage or weaken the heart and blood vessels, or cause problems with clotting or blood lipids (cholesterol and fatty acids).
Some of these cardiovascular effects can come on during the course of cancer treatment; others can strike years later after the patient is cancer-free.
How Doctors Protect Your Heart During Cancer Treatment
Because of the risks associated with cancer treatment and the heart, cardiologists and oncologists have created a subspecialty called cardio-oncology, which aims to protect patients’ hearts during cancer treatment. “We work with the oncologist on trying to adjust the doses of radiation therapy, or the frequency and amount of chemotherapy, and correlate that with their risk of having heart failure,” says Satjit Bhusri, MD, a cardiologist at Lenox Hill Hospital in New York City.
To prevent and lower a patient’s risk of heart failure, cardiologists may also perform tests that diagnose heart failure before a patient even feels heart failure symptoms. They may also suggest certain lifestyle modifications to reduce heart failure risk.
“I want a patient’s blood pressure to be well controlled, I want their diabetes to be under control, I want them to be at an ideal body weight so that I can put them in the safest position possible to undergo their cancer therapy and to decrease their risk of having a problem down the line with heart failure,” says Dr. Bloom.
Learn more about other heart failure risk factors here.
Dr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.Satjit Bhusri
Dr. Bhusri is an attending cardiologist at the Lenox Hill Heart & Vascular Institute and an assistant professor of cardiology at Hofstra Northwell School of Medicine.
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As cancer therapies become
more widely available and
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there are more different types,
we are starting to understand that many of
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them can have untoward
effects on the heart.
00:00:13,686 --> 00:00:19,546
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As we're only recently finding out,
it's not the cancer,
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it's more of the cancer treatment,
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the chemotherapy and radiation therapy,
that leads to heart failure.
00:00:30,580 --> 00:00:33,910
But I think that it's important for
us to understand, as doctors and
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as patients, that there can be risks
associated with these therapies.
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For example, risk of heart failure,
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risk of heart rhythm abnormalities,
risk of heart attack, or risk of stroke.
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Things like that.
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In fact, the American Heart Association
and the American College of Cardiology
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have now created a sub-specialty
known as cardio-oncology.
00:00:53,210 --> 00:00:58,480
Where we look and we work with
the oncologist on trying to adjust
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the doses of radiation therapy or
the frequency and amount of chemotherapy,
00:01:03,590 --> 00:01:07,440
and correlate that with their
risk of having heart failure.
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We actually now have more increasing
imaging modalities that can catch
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heart failure before you even know
you have symptoms of heart failure,
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due to chemotherapy and radiation therapy.
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It's not to say, at all,
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that you shouldn't get your cancer
therapy and beat the cancer.
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In fact, I always say to patients
when I'm seeing them in the office
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before they start their cancer therapy.
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My job is to make you be in a position
where you're the safest possible to
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undergo the therapy so
that you can beat the cancer, and
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come back to me just as a well patient and
not have any complications.
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So what we like to do is we
like to try to prevent that by
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understanding the risk factors of
a patient going into cancer therapy, so
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that we might modify those risks.
00:01:49,800 --> 00:01:53,380
For example, I want a patient's blood
pressure to be well controlled.
00:01:53,380 --> 00:01:55,369
I want their diabetes to be under control.
00:01:55,369 --> 00:01:57,486
I want them to be at an ideal body weight.
00:01:57,486 --> 00:02:01,493
So that I can put them in the safest
position possible to undergo their cancer
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therapy safely, and so
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as to decrease their risk of having a
problem down the line with heart failure.
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- Alexandre J, Cautela J, Ederhy S, Damaj GL, Salem JE, Barlesi F, Farnault L, Charbonnier A, Mirabel M, Champiat S, Cohen-Solal A, Cohen A, Dolladille C, Thuny F. Cardiovascular Toxicity Related to Cancer Treatment: A Pragmatic Approach to the American and European Cardio-Oncology Guidelines. J Am Heart Assoc. 2020 Sep 15;9(18)
Han, X., Zhou, Y. & Liu, W. Precision cardio-oncology: understanding the cardiotoxicity of cancer therapy. npj Precision Onc 1, 31 (2017)Nair N, Gongora E. Heart failure in chemotherapy-related cardiomyopathy: Can exercise make a difference?. BBA Clin. 2016;6:69-75