Cancer Therapy: Can It Hurt Your Heart?
Thursday Aug 01, 2013, 12:00PM - 01:00PM (EST)
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.
Can you speak to the incidence of heart failure among adult survivors of pediatric malignancies, please.
We are in the process of answering that question. We have partnered with St. Jude's Hospital in Memphis, TN, and we are evaluating their cohort of survivors of childhood cancer to accurately deliniate the rate of toxicity. Juan Carlos Plana, MD
Could you also discuss strain imaging: what it is and its role in individuals undergoing cardiotoxic regimens?
Strain imaging is new technology that allows us to better characterize the function of the heart (how good the squeeze of the heart is). By doing so, it allows us to identify small changes in the function, and as a result, identify patients who are experiencing early toxicity. Juan Carlos Plana, MD
I went through chemotherapy and radiation therapy for almost a full year, 14 years ago. The good news is – I’m still here! The bad news is I’ve had arrhythmia problems ever since my treatment. I have never been evaluated by a cardiologist. Do you think it’s too late now, or is it one of those “never-to-late” situations?
I am happy to hear you are doing well. If you are having arrhythmias, I would suggest you undergo an echocardiogram to assess the strength of your heart. You would also benefit from seeing a rhythm cardiologist, known as an electrophysiologist, to further assess the arrhythmias and to recommend the best treatment. It is not a “never-to-late” situation. Karen James, MD
I've had 2 cancers-stage IV HodgkinsLymphoma & stage IIIa BReast Cancer. In 1983 I had mantle radiation, and MOPP/ABVD chemo regiment. 2005 I developed BC from the rads I received in 83. For the BC i received CAT chemo regimen, and additional rads to my chest. Currently I suffer severe RIBP (Radiation Induced Brachial Plexopathy). And most recently congestive heart failure and severe cardiomyopathy from the combo of chemo/rads. I will be scheduled for heart transplant testing within this month, to eventually determine a placement on the transplant list. I tell this story, in hopes that all receiving chemo/rads insist on cardio work ups before cancer therapy, and during cancer therapy and very importantly after cancer therapy. Late effect side effects can happen anytime... Months, years, decades later. These chats are so important.... Are guidelines given to, and required to follow, by all Oncs to insist on evaluations such as heart, and rad damage to nerves, etc?
We have recently published the expert consensus on the imaging evaluation of the patient after radiation therapy and we are in the process of finalizing the expert consensus on the imaging evaluation of the patient during and after chemotherapy. Thank you so much for your comments!!! Juan Carlos Plana, MD
My husband has severe CHF, an implanted biventricular device and now they just found a “spot” on his lung. If this turns out to be cancerous, should he avoid chemotherapy because of his heart condition?
He may still be evaluated for the best treatment options for the lung spot, if it turns out to be cancerous. He would need an update of his cardiac status, to allow the oncologist (cancer doctor) and cardiologist to help arrive at the safest and most effective treatment plan for your husband. Karen James, MD
My Mom was recently diagnosed with breast cancer and her doctor is recommending chemotherapy and possibly radiation therapy. What questions should I be asking her doctors and what things do we need to consider? I'm at a loss and any guidance will be appreciated.
You should, of course, know your mother's stage of disease, as well as important characteristics of her tumor, namely, the estrogen receptor, progesterone receptor, and HER2 status. In addition, you should know what medicines her oncologist plans to use and what their expected side effects would be. For instance, if your mother is to receive Adriamycin or Herceptin, a cardiac evaluation should be undertaken. G. Thomas Budd, MD
I was just diagnosed with breast cancer and am scheduled to have a lumpectomy on July 29th. My doctor has already told me that I will probably need chemotherapy and radiation therapy after the surgery. Is there anything I can do to reduce my risk of a heart problem, before I have surgery or further treatment?
I recommend that you discuss with your oncologist the type of treatment that he has prescribed. If the treatment could be potentially cardiotoxic, I will recommend baseline echo and cardiology consultation so that if you have risk factors (hypertension), they can be treated prior to the initiation of therapy. Juan Carlos Plana, MD
Years ago my cancer was treated with Doxorubicin (Adriamycin). I got a message about this health chat last night and it piqued my interest so I went Googling. I never knew that this drug could cause a problem for my heart. Thank you for letting me know about this potential problem. I have never had symptoms but it would be helpful to know what symptoms to watch for, just in case.
It would be useful for you to undergo a screening echocardiogram even if you are feeling well just to assess for any silent heart muscle weakness and possibly allow starting of medication to help preserve its function. Symptoms that sometimes occur if the heart becomes progressively weak are shortness of breath with activity, shortness of breath when you lie down, and/or swelling in the legs. Karen James, MD
A fairly recent (April 2013) CT for recent diagnosis of metastatic bone cancer from IIIa BC in 2001 showed "a small pericardial effusion". Is this reason for concern? Have had some small discomfort in my back behind heart area off and on for quite some time. Also, last fall in early morning hours woke up with severe pain in left arm and some chest discomfort. EKG showed normal.
Based upon what you are telling us, we will recommend a consultation with your cardiologist. Juan Carlos Plana, MD
Hi, thank you for taking my question. I have to meet with my oncologist next week to talk about my treatment for lung cancer. It would be really helpful if you could let me know what questions I should ask about my heart or any other issues that I'll be facing re: cancer treatment.
Be sure to ask your doctor if there will be any effects on your heart from this treatment, and what cardiac evaluation he/she would recommend. Particularly, ask whether radiation treatments will effect your heart. G. Thomas Budd, MD
I had Ewing's Sarcoma 35 years ago in 1978 and I am now almost 5 and 1/2 years out from heart transplant at the Cleveland Clinic; I am also a participant of the CCSS out of St Jude which has a wealth of long term data.
Thank you for your comments! We will start to analyze our data in the beginning of 2014 and publish our results. Juan Carlos Plana, MD
Thank you for participating int he CCSS! G. Thomas Budd, MD
What kind of heart tests should be done before beginning cancer treatment? Unfortunately, it's too late for me, but I wanted to ask this question for all those people who didn't know that cancer treatment could hurt their heart.
We recommend a baseline echo with a strain imaging (where available). Juan Carlos Plana, MD
Unfortunately, we only have time for one more question.
Once someone has been diagnosed with cancer, should they see a heart doctor before they have surgery to remove the tumor, or after? Also, how much time do they have before they have to begin chemotherapy? How much time before beginning radiation therapy? Is there a recommended time schedule?
Unfortunately, it is not possible to give one answer that applies to all patients. The answers to your questions depend upon your cardiac history, the surgery planned, the chemotherapy to be given, and your recovery after surgery. These are all excellent questions that you should discuss with your treatment team. G. Thomas Budd, MD
Thank you everyone for participating in today's chat and a big thank you to Dr. Budd, Dr. Plana and Dr. James for sharing your knowledge with us! Hope to see everyone back here for another chat soon!
Thank you everyone for your great questions. We enjoyed answering. We are all very passionate about this topic and feel that the more we educate the better for patients. At Cleveland Clinic we have a dedicated Cardio Oncology Center if you would like to learn more, please call one of our heart nurses at 866.289.6911. visit clevelandclinic.org/cardiooncology