The explosion of new anti-cancer therapies , successful in treating cancer,will increase the number of cancer survivors or cancer free patients; we are learning now that  chemotherapy , radiation therapy and predisposition to develop cancer are risk factors for Heart disease.

For years, long-term cardiac and vascular consequences of novel cancer therapies remain largely unknown; over the last few years, cardio-oncology research focused on risk factor stratification, and prevention of  developing cardiac and vascular disease.We are increasing our abilities to help patients at the begging of cancer therapy , during therapy, and years after .

 

Cancer and cancer related therapy pose a risk of developing heart disease even 15 years after cancer resolution. 

Most of the research studies were done in breast cancer patients, and breaking news regarding cardiac protective therapy and detecting patients at risk of heart disease are numerous.

However, other cancers are recently associated with cardiac future risk: Screening for heart disease in Testicular cancer survivors- The Platinum Study, JNCCN, march 2018. The study states that testicular cancer survivors are at risk of cardiac complications including High Blood pressure, high cholesterol, obesity, and coronary heart disease.

What are the Risk factors for developing heart disease?  Mayo Clinic, 2014, modified by Irina Staicu, MD

 

Chemotherapy Risk associated factors; Cardiology consultation before or during treatment is recommended if more than 1 is present 

• Any Anthracycline exposure (<400mg/m2) or other potentially cardiotoxic chemotherapy

Including:  Trastuzumab, Sunitinib, Cytoxan, Bevacizumab (Avastin)

• High dose Anthracycline exposure

  –          Doxorubicin>400mg/m2

  –          Daunorubicin>500mg/m2

• Anthracyclines in combination with either:

  –          Trastuzumab

  –          Ado-Trastuzumab

  –          Cyclophosphamide

  –          Taxanes

• Young or Advanced Age at Exposure (<15y/o or > 65y/o)

• PreExisting Cardiac  disease or risk factors:  HTN, Diabetes

  High cholesterol, CAD, Peripheral arterial disease

  Myocardial infarction, Heart failure, Smoking, Family history of heart disease

• Mediastinal radiation

• Abnormal baseline Ejection fraction<55%

• Decrease in ejection fraction >10% during treatment

Radiation therapy risk associated factors; Cardiology consultation before or during treatment is recommended if more than 1 is present 

• Total dose >30-35 Gy

• Presence of tumor next to the heart

• Age <15y/o or > 65y/o)

• Associated Cardiotoxic chemotherapy (e.g., Anthracycline, Trastuzimab)

• PreExisting Cardiac  disease or risk factors:  HTN, Diabetes

  High cholesterol, CAD, Peripheral arterial disease

  Myocardial infarction, Heart failure, Smoking, Family history of heart disease

• Left Ventricular Dysfunction (EF<55%)

• New or worsening valvular disease or pericardial effusion

• Signs or Symptoms of Heart Failure/Angina/Neurological symptoms

 

Any of the above Risk factors present before or during Chemotherapy or Radiation Therapy , require cardiology consult, and Cardio-Oncology approach for further treatment.

Cardio-Oncology is a developing field and it may take years until complete awareness and acceptance occur. Be knowledgeable and lead your own treatment; know what to ask and when to ask.

Breast Cancer patient of today , should not become a heart patient of tomorrow