The Link between Cancer Treatment and Heart Complications: The Risks, Research and What You Should Know
Written by Bryan Heart cardiologist John Steuter, MD
In recent years, there has been progress in cancer therapy to improve survival from cancer, however this has led to an increased number of cancer survivors who are at risk for cardiomyopathy secondary to the cardio-toxic nature of some treatments.
Cardio-oncology is an emerging field focused on finding a balance between cancer treatment effectiveness and reducing the adverse cardiovascular effects as a result of treatment.
Chemotherapy can create serious heart complications for some cancer patients such as cardiac dysfunction (CRCD) otherwise known as heart failure. CRCD is classified into two types.
CRCD is classified into two types:
- Type I (anthracycline-associated cardiac dysfunction)
Anthracycline is a drug used in chemotherapy to treat many cancers, including leukemias, lymphomas, breast, stomach, uterine, ovarian, bladder cancer and lung cancers. This drug can cause cardiotoxicocity which presents risk of cardiomyopathy leading to heart failure.
Treatment and prognosis of the cardiomyopathy is dependent on numerous factors.
- Type II (trastuzumab induced cardiac dysfunction, related to HER2 blockade)
Trastuzumab is a monoclonal antibody that interferes with the HER2/neuro receptor and is mainly used to treat breast cancer. One of the risks of Trastuzumab - while rare - is heart failure including congestive heart failure.
Progressive cancer therapy research is being conducted to improve the survival rate of cancer patients at risk for cardiomyopathy secondary to the cardio-toxic nature of some treatments.
A recent study presented at the 2015 American Heart Association (AHA) meeting demonstrated improvement in cardiac function in those patients prophylactically treated with candesartan for hypertension. The study is Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy (PRADA).
Taking a strong interest in the topic, myself, I conducted a scientific study which was published in the American Society of Hematology Blood Journal to assess the utility of pre-chemotherapy echocardiograms and whether routine testing changes chemotherapy management.
Other studies have demonstrated the importance of early diagnosis of CRCD and show improved outcomes the earlier treatment is started. Such methods involve measuring left ventricular strain and close left ventricular function monitoring using cardiac MRI.
What You Should Know
At Bryan Heart we have expertise and advanced technology in this area.
- We can collaborate with you to care for your patients to minimize the risks.
- We also are able to follow patients over time to assess risks. This includes using an advanced imaging technique to look for cardiotoxic effects in patients using echocardiographic strain, which is a non-invasive method for assessing the heart and cardiac MRI. Bryan Heart is one of few in the state to perform both as part of this technique.
If you have questions about patients at risk or who have developed chemotherapy related cardiac dysfunction, please contact our office at 402-483-3333.