Managing Cancer Treatment While Protecting Heart Health

Cancer treatments have made significant strides in recent years, offering hope to many patients. However, these treatments can sometimes have unintended effects on cardiovascular health. Understanding the connection between cancer treatments and heart disease is crucial for patients and healthcare providers alike.

The Cancer-Heart Disease Connection

According to Dr. Anusha Ganapati Bhat, a cardio-oncologist with Baystate Cardiology, cardiovascular disease (CVD) is the leading cause of non-cancer deaths in patients with cancer. She notes, “Roughly 30-40% of the cancer patients we see have some form of CVD. There are a lot of overlapping risk factors between CVD and cancer. While some may have pre-existing CVD before receiving a diagnosis of cancer, others may develop CVD during their cancer journey. This risk for CVD-related death is highest in the first year after a cancer diagnosis, but overall, cancer patients with CVD have a two- to six-time higher risk of death due to CVD than the general population.”

Dr. Bhat adds that a dual diagnosis of CVD and cancer presents some specific challenges. Most notably, she says, “An unfortunate side effect of some cancer treatments is a worsening of CVD. As a result, this impacts what cancer treatment options are available to patients with CVD.”

Impact of Cancer Treatments on Heart Health

As a cardio-oncologist, Dr. Bhat focuses on treating heart disease during all phases of the cancer journey.

“Ultimately,” she says, “early diagnosis helps prevent further cardiac damage.” Part of a mitigating risk involves choosing the treatment with the least chance of harm to the heart but the necessary efficacy for addressing the cancer.”

These decisions are always made with the input of members of a patient’s cardiology and oncology teams. “When there is a dual-diagnosis patient, we go from being separate teams to one unified team,” she explains. “Every decision made about a treatment plan is evaluated to minimize heart risks and allow patients to receive vital cancer therapies safely and effectively.”

Cancer Treatment Options and Their Cardiac Health Concerns

Common cancer treatment options and cardiac concerns include:

Radiation Therapy

Radiation to the chest, particularly when directed at the left chest, in case of breast, lung cancers and lymphoma, can cause hardening of the coronary arteries, increasing the risk of heart attack.

Chemotherapy

High doses of certain chemotherapy drugs can weaken the heart's ability to pump, cause heart failure, or lead to issues like irregular heart rhythms or spasms in blood vessels.

Targeted Therapies

Intended to attack cancer cells, targeted therapies can attack other cells, including those in the heart. Damage can cause high blood pressure, heart failure, and heart disease. 

Immunotherapy

Immunotherapy uses a patient's immune system to fight cancer by stimulating the system's ability to recognize and destroy cancer cells.  Immunotherapy can lead to heart problems, including myocarditis, arrhythmia, and heart failure. 

Medications

Hormone modifying medications: Some cancer medications, such as the ones used in breast cancer and prostate cancer can dramatically raise blood pressure, alter lipid profiles or cause insulin resistance, further impacting cardiovascular health.

The Role of Monitoring Heart Health During and After Cancer Treatment

Dr. Bhat explains, “Monitoring during treatment is essential and complicated as many of the side effects of cancer treatments overlap with symptoms of heart disease.”

Shared signs and side effects of heart disease and cancer treatments include:

• Shortness of breath
• Chest pain
• High blood pressure
• Heart palpitations
• Dizziness or lightheadedness
• Increase in weight from water retention or swelling in the legs, ankles, or abdomen
• Heart failure
• Abnormal heart rhythms
• Pericarditis (inflammation around the heart)
• Myocarditis (inflammation of the heart muscle)
• Coronary artery disease
• Heart valve disease

She adds, “Because we don’t ever want to stop treatment prematurely, we constantly evaluate a patient’s heart function to understand what’s happening and why.”

Common monitoring efforts include a blood test to check biomarkers, an electrocardiogram to assess heart function, or an echocardiogram to look at the chambers and valves of the heart. If the results of those measures are inconclusive, a cardiac MRI, nuclear imaging, cardiac CT, or coronary angiogram may be recommended.

Using the information revealed through monitoring, the care team can re-evaluate the cancer treatment plan and make adjustments to spare the heart any further damage.

If a serious heart condition is identified, it can often be managed through stents, valve replacements, defibrillator implants, and catheterization, with a goal to avoid interruption to cancer treatment.

Once treatment is concluded, your doctor will establish a schedule for ongoing cardiac monitoring based on the type of treatment received and the known risk factors.

In most cases, echocardiograms are scheduled for at least the first year, with frequency depending on risk factors. For patients at significant risk of heart disease or failure, monitoring may continue for several years with less frequent echocardiograms. Patients with pre-existing heart conditions may require more intensive monitoring. 

Dr. Bhat cautions, “Regardless of any established monitoring schedule, if you experience any symptoms like chest pain or shortness of breath, contact your healthcare provider immediately.”