Health Chats
Cancer Therapy: Can It Hurt Your Heart?
Thursday Aug 01, 2013, 12:00PM - 01:00PM (EST)
CCFCardioOncology MDBlank
Current treatments for cancer are saving lives and have been one of the greatest achievements in modern medicine. However, many of the lifesaving cancer therapies can have significant and serious cardiovascular side effects, such as heart failure, thromboembolism, severe hypertension and arrhythmias. Take this opportunity to learn more about cancer and the effect on heart disease and have your questions answered by cardiologists and an oncologist from Cleveland Clinic.
MedHelp:
Hello everyone and welcome to today's Health Chat!
MedHelp:
I would like to introduce our three experts:
MedHelp:
Juan Carlos Plana, MD - Cardiologist and Co-Director of the Cleveland Clinic Cardio-Oncology Center
MedHelp:
G. Thomas Budd, MD - Oncologist and Co-Director of the Cleveland Clinic Cardio-Oncology Center
MedHelp:
Karen James, MD, Cardiologist
CCFCardioOncologyMD:
Hi, everyone, thank you for having us. Current treatments for cancer are saving lives and have been one of the greatest achievements in modern medicine. However, many of the life saving cancer therapies can have significant and serious cardiovascular side effects, such as heart failure, thromboembolism, severe hypertension and lethal arrhythmia. Lets get started with the chat. Juan Carlos Plana, MD

SLBCA:
I am starting breast cancer radiation--using the Canadian protocol of 16 days--higher levels of radiation. What are the potential effects on heart?
CCFCardioOncologyMD:
Radiation therapy can affect the different parts of the heart. Patients can experience problems with the pericardium (bag that covers the heart), the muscle of the heart, the valves of the heart, and the coronary arteries.
CCFCardioOncologyMD:
It is very important that you get follow-up through the years so that, if you develop these complications, they can be rapidly identified and treated. Juan Carlos Plana, MD
AuburnFire:
I need to get permission from my Primary doctor in order to see a specialist like a cardiologist.  My primary RARELY allows me to see a specialist, much less both a cardiologist and a cancer specialist.  Is seeing both an oncologist and cardiologist before treatment for cancer considered “customary”?   If not, is there any support data that I can use if I need to fight to get this covered?
CCFCardioOncologyMD:
If you are undergoing cancer treatment, you will certainly benefit from seeing an oncologist (cancer expert) . In regards to your question about seeing a cardiologist, we strongly recommend a cardiology consultation if you will receive treatments that can be toxic to the heart.
CCFCardioOncologyMD:
Juan Carlos Plana, MD
Carol 1:
I was just reading up on how chemotherapy can cause heart damage.  In one of the articles I read, it said that chemo can weaken the heart and cause arrhythmias.  Is this true?  If so, what can be done to prevent this from happening?  Are there certain chemo drugs that are more harmful than others?
CCFCardioOncologyMD:
Some forms of chemotherapy can weaken the heart and as a result of that can secondarily, cause arrhythmias. Some therapeutic chemotherapy agents can directly cause arrhythmias. For this reason, we evaluate the heart before chemotherapy begins to asses that the heart function is normal. If we find any abnormalities of function, we initiate cardiac medications and if develops during chemotherapy we if on the other hand, new cardiac dysfunction develops while on cancer therapy, heart medications can be introduced that point and chemotherapy temporarily held. As far as arrhythmias as concerned, if there are underlying heart disease, we sometimes avoid certain types of chemotherapy medications. Karen James, MD
Natastron:
My sister went through chemotherapy about 6 years ago and she still suffers with what we call “chemo-brain”.   We laugh about it, but it is really beginning to concern us because her cognitive skills – especially memory and for some reason her concept of time has changed dramatically.  I know this is a health chat about how cancer treatment can hurt the heart, but I wanted to ask if it also can hurt the brain?
CCFCardioOncologyMD:
There can be cognitive problems associated with chemotherapy, although this phenomenon is not as well understood as we like. Usually, the effects are transient, though occasionally they are long lasting. We are currently studying this problem, but the exact mechanisms responsible have not been delienated. Your sister should see a neurologist for evaluation in order to be sure there is not some other problem responsible for her memory problems. G. Thomas Budd, MD
HesAPooka:
Do people who are predisposed to certain arrhythmia's or who experience a large amount of arrhythmia's per day incur greater risks of cardiac arrest during cancer treatments and what is done to prevent this from occurring?  
CCFCardioOncologyMD:
Yes, arrhythmias can be more frequent during chemotherapy in patients that already have them prior to initiation of therapy. It is very important that you see a cardiologist in preparation and during chemotherapy so that along with the oncologist, attention can be paid during therapy to the choice of chemotherapeutic agents, antibiotics, and careful survellaince to electrolyte disturbances can be done.  Juan Carlos Plana, MD
Winick:
I am cancer survivor X3 and awaiting heart transplant.How do we reach the millions of survivors who do not know they are at risk for heart failure?
CCFCardioOncologyMD:
It is important for all patients who have undergone chemotherapy to undergo an echocardiogram to assess for any heart muscle dysfunction that may have occurred from past chemotherapy. If it is found, heart medications may be needed to help preserve heart function. Only a small percentage of patients after chemotherapy require evaluation for heart transplant if they are severely limited, and if they have been cancer-free for a number of years. Karen James, MD
stephiedee:
Dr. Plana, Stephanie Zimmerman, here. Would you now speak to chemotherapy-related heart failure and why it is potentially more amenable to prevention?
CCFCardioOncologyMD:
Hi Stepanie! Great seeing you in this web chat! As you  know, early detection of cardiac toxicity is of paramount importance. Cardiotoxicity may be reversible if identified and treated early. As a result, we emphasize the use of new technologies like strain imaging (a special type of echo) that will allow us to recognize toxicity very early. Juan Carlos Plana, MD
hamids:
Are there other chemotherapy drugs that  don’t cause heart damage but are as effective against cancer?
CCFCardioOncologyMD:
In some cases, chemotherapy regimens employing medicines that have minimal cardiac side effects can be used. Of course, these medicines may have other side effects that need to be considered. It is important to individualize treatment based on effectiveness, side effects, and the patient's medical condition. G. Thomas Budd, MD
Winick:
How commom is life threatening arrhythmias with radiation-induced restrictive cardiomyopathy ?
CCFCardioOncologyMD:
Restrictive cardiomyopathy refers to the heart muscle becoming stiff and scarred after radiation therapy. Arrhythmias, per se, are somewhat uncommon in restrictive cardiomyopathies. The more common problem is fluid retention due to the stiffness of the heart muscle.  Karen James, MD
BK2005:
Have there ever been any long-term studies done on the effects of chemotherapy?  By long-term I mean 5, 10, 20, 25 years post-treatment.  If so, what are the really long-term effects on patients who have had chemotherapy and radiation therapy?
CCFCardioOncologyMD:
Indeed, the effects of radiation are seen 20 to 30 years after receiving it. In terms of the chemotherapy, the rate of heart failure appears to be 5% for patients treated with anthracyclines (Adriamycin and similar drugs); 12% for Trastuzumab; and 20% for the combination at 5 years. The rates increase if the patient is older than 65 years.
CCFCardioOncologyMD:
Juan Carlos Plana, MD
CCFCardioOncologyMD:
Preface to above answer: Other studies have shown lower rates of heart problems and it is clear that more research is needed. G. Thomas Budd, MD
lexi871987:
I’m having chemotherapy for breast cancer now. I go every few weeks and am about halfway done. Should I see a cardiologist right away or is it too late for me?
CCFCardioOncologyMD:
It is never too late to see a cardiologist. It will be very important that you see one if you are receiving medications that are known to be toxic to the heart. Juan Carlos Plana, MD