A wrenching choice: Fight cancer or heart problems?

Many cancer patients face an unexpected dilemma during treatment: take cancer medication that could possibly damage their heart—or stop taking the medication and run the risk that the cancer will spread, Lucette Lagnado writes for the Wall Street Journal.

What's trending in cardiovascular services?

Miracle drugs—at a price

According to Saro Armenian, a pediatric oncologist at City of Hope, it's only because more cancer patients are surviving their diagnoses that the cardio-toxicity of some cancer drugs came to light.

Armenian explained that while the cardio-toxic effects can sometimes be spotted quickly, they can in other instances take several decades to surface. According to Armenian, pediatric oncologists started to voice concern about the potential side effects of cancer drugs about 20 years ago, when they began to notice that many survivors of childhood cancer were presenting with heart problems.

"Our cancer outcomes are improving. People are living longer," Armenian said. "But we have to recognize there are new issues after the cancer treatment, and that the risk is much greater than in the general population."

One such cancer drug, according to Lagnado, is Herceptin—a medication that has become "the standard of care" for aggressive forms of breast cancer, according to the drugmaker, Genentech. It has improved survival rates among many cancer patients who have received chemotherapy treatment alongside it; however, the drug also runs the risk of causing heart issues.

Among women who take Herceptin, 72 percent with a specific type of early-stage breast cancer remain free of the cancer for a decade. "It is a remarkably effective drug," said Richard Steingart, chief of cardiology at Memorial Sloan Kettering Cancer Center in New York. However, among those same women, 10 to 15 percent ultimately develop heart problems. But while the possibility of developing heart issues is certainly a risk, it's one that Steingart believes is "manageable."

'A balancing act'

To raise awareness about the cardio-toxicity of certain cancer drugs, Armenian led a team of experts to create guidelines for the American Society of Clinical Oncology.

The guidelines, published in March in the Journal of Clinical Oncology, state, "Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy." According to the guidelines, patients who are deemed at risk of heart problems as a result of their cancer treatments—either recent or long past—should be monitored and tested.

The playbook for optimizing structural heart programs

Megha Agarwal, a cardiologist at UCLA Health Specialty Practice in Ventura, California, said such ongoing attention to heart issues for cancer patients is vital. Agarwal explained that while many cancer survivors are vigilant about getting checked for cancer, they typically ignore the chances of heart problems.

"Every one of those survivors, they go back to their oncologists; (the female patients) get screening mammograms, they get routine colonoscopies, their doctors reiterate the importance of wearing sunscreen to prevent melanoma," Agarwal said. "But once you cross 10, 12 years, [cancer] isn't your main issue: What you should be concerned about is heart disease, and everyone forgets that."

But in the end, patients and doctors have to assess the benefits and dangers on a case-by-case basis, Lagnado writes. As Steingart said, "It is a balancing act" (Lagnado, Wall Street Journal, 5/31).

What's trending in cardiovascular services?

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