Some people beat cancer, only to learn that the powerful chemotherapy drugs or radiation treatments that saved their life caused lasting damage to their heart.
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Why you need a cardio-oncologist if you have cancer
The anthracyclines—doxorubicin in particular—are among the most common cardiotoxic chemotherapy agents. Cumulative doses can cause heart failure or cardiomyopathy any time from the first year after therapy to several years after treatment ends.
Trastuzumab, a breast-cancer drug, is known to cause heart failure and arrhythmias during treatment. Tyrokinase inhibitors can cause hypertension.
Radiation therapy tends to damage the heart valves.
That’s why it’s important for cancer patients to be followed by a cardiologist or cardio-oncologist, who is familiar with the effects of chemotherapy and radiation therapy on the heart.
“Our goal is to help patients complete their cancer treatment without incurring damage to the heart,” says Balaji Tamarappoo, MD, PhD, Co-Director of the Cardio-Oncology Center at Cleveland Clinic. “It is particularly important for patients with—or at risk for—heart disease.”
Symptoms of heart disease include weakness, fatigue, swelling of the legs and feet, chest pain, arrhythmias and dizziness.
Watching for damage
Dr. Tamarappoo recommends obtaining a noninvasive echocardiogram (“echo”) at a center with experience in chemotherapy related complications before starting chemotherapy. “Knowing the patient’s baseline heart function gives us a point of reference for any changes that may occur during or after therapy,” he says.
Depending on the chemotherapy agents used, a second echo may be taken midway through treatment. If the heart function has changed, beta-blockers and ACE inhibitors may be prescribed to prevent further damage during treatment.
“This also provides an opportunity for the oncologist to consider using different chemotherapy agents,” says Dr. Tamarappoo.
After the patient completes their treatment, he looks again. If no disturbing changes have taken place, he takes another echo one year later. “From this point on, a repeat echo is only necessary if symptoms of a heart problem arise,” he says.
For cancer patients undergoing radiation therapy, pre- and post-treatment echos are also advised to evaluate valve function. “If we see calcifications, the patient will need an echo every couple of years to monitor the possible development of valve disease,” says Dr. Tamarappoo.