Some life-saving cancer treatments can take a toll on how the heart functions. A cardio-oncologist explains who is at risk and how to mitigate complications.
When someone is tasked with battling cancer, maintaining heart health is often an afterthought. However, as more and more research reveals that some cancer treatments can potentially impact cardiovascular function, experts believe it should be integrated into patients’ long-term cancer care plans.
Cancer vs. the Heart
Cancer itself will rarely have a direct impact on the heart, says cardio-oncologist Dr. Eugene Storozynsky, who specializes in treating heart disease in those who have or have had cancer, rather than a broad spectrum of patients.
The likely culprit? Certain powerful and newly discovered targeted treatments – chemotherapy, immunotherapy, or radiation (to or around the chest) – can yield consequences, especially for those who are already at an increased risk for cardiovascular, or heart disease.
Complications can appear during treatment, later in the course of the disease, or even years after remission, explains Dr. Storozynsky. The most common cardiac side effect of cancer treatment is tachycardia (elevated heart rate), often coupled with fatigue.
“It can be difficult to determine whether these symptoms stem from a heart condition or not, as most patients who undergo intensive chemo experience fatigue, and may have a rapid heart rate due to stress or reduced blood counts – not necessarily due to a new heart condition,” continued Dr. Storozynsky. “Monitoring changes with a cardio-oncologist is incredibly important to rule out anything concerning and prevent more serious disease from developing.”
Other complications that can result from cancer treatment include:
- Cardiac arrhythmias/irregular heartbeat
- Coronary artery disease/narrowing of arteries
- Valvular heart disease/damage to heart valves
- Congestive heart failure/damage to heart muscle
- Pericarditis/problems with the outermost layer of the heart
- Blood clots
Why Cancer Treatment Can Affect the Heart
While it’s not exactly known why these complications can occur, experts believe there could be a link between how cancer treatments impact the nervous system, and then how the nervous system, in turn, impacts the heart, explains Dr. Storozynsky.
Additionally, certain chemotherapy drugs are known to induce cardiotoxicity, or damage to the heart muscle itself, in a subset of people, continues Dr. Storozynsky. Other medications are known to increase blood pressure; if hypertension becomes significant and persistent, it can lead to heart dysfunction, stroke, and kidney disease. However, if appropriate and timely intervention is taken, these various heart-related complications can be avoided or reversed.
Who is at Risk?
Not everyone who has cancer will face these complications. Studies indicate that around 10-15% of those with cancer develop cardiotoxicity to some extent, requiring cardio-oncology care.
Cancer treatments can exacerbate the risk that’s already there. So, you should be more cautious if you:
- Have pre-existing heart disease.
- Are already at an increased risk for cardiac complications due to family history, a sedentary lifestyle, or personal history of diabetes, high blood pressure, high cholesterol, obesity, smoking, etc.
- Have a cancer treatment course with a known drug linked to cardiotoxicity.
How a Cardio-Oncologist Can Help
“This doesn’t mean we should stop using life-saving treatments that efficiently attack cancers. But we should take a multi-disciplinary approach and complement cancer care with cardiology. This is where the growing field of cardio-oncology comes into play,” says Dr. Storozynsky.
Cardio-oncologists work collaboratively with the oncology team, notes Dr. Storozynsky. “They can continue to administer necessary treatment, while we prevent unnecessary complications.”
Patients may benefit from seeing a cardio-oncologist during or after treatment, while others, whose heart health was never initially monitored during their cancer, may need to re-engage with this kind of care years later, suggests Dr. Storozynsky. “We’ve seen patients decades after they’ve had cancer who’ve suffered cardiac events that may have been preventable if they had been seen by a cardio-oncologist at some point during their survivorship.”
Surviving Cancer and Reducing Your Heart Disease Risk
It’s about being proactive, says Dr. Storozynsky. “Survivorship after cancer is a continuum and maintaining your heart health is a core component. When you’re in remission, you follow up with your oncology team. When you’re at risk for cardiac complications, you should also continue to follow up with your cardio-oncology team. It’s not just a one and done.”
Cancer treatment (chemo, immunotherapy, or radiation) should be considered as a risk factor for future heart disease; thinking of it as such may lead to a healthy lifestyle to reduce the risk of developing preventable heart disease.
How else can you stay on track with your heart health even if you’re “in the clear?” Dr. Storozynsky lends the following tips for leading a heart-healthy lifestyle and reducing your overall heart disease risk:
- Know your numbers, such as cholesterol, blood pressure, weight, and sugars (indicates pre-disposition to diabetes), and don’t let them go unmanaged when there’s a spike.
- Exercise several times per week. This doesn’t necessarily mean going to the gym. It can be as simple as walking for 30 minutes, four to five times per week. Walk with a purpose. Don’t stroll. Pick up the pace as your body allows you to.
- Follow a predominantly nutrient-rich diet, with everything in moderation.
Keep in mind, heart disease remains the leading cause of death in the U.S., but it’s also highly preventable, adds Dr. Storozynsky. When you’re high-risk – for any reason – you should be monitored life-long. If you have cancer or a cancer history, talk to your oncologist or your primary care physician about whether cardio-oncology is right for you.