Cancer treatments may be linked to heart disease

According to a 2021 study published in the American Journal of Cancer Research, a major side effect of anticancer treatments is cardiotoxicity, and it can "present both acutely during treatment and chronically even years after treatment has been completed." Cardiotoxicity may lead to cardiomyopathy, heart attack, coronary artery disease, heart failure, heart valve disease, and arrythmias.

Some cancer treatments that are associated with a higher risk of cardiotoxicity include:

• Cisplatin, which is used to treat bladder, ovary, and testicular cancer
• Adriamycin, which is used to treat leukemia, lymphoma, breast cancer, sarcoma, and multiple myeloma
• Herceptin, which is used to treat breast cancer, stomach cancer, and cancer of the gastroesophageal junction
• Carboplatin, which is used to treat ovarian, bladder, head and neck, lung, cervical, and sometimes testicular cancer

Currently, the Cleveland Clinic estimates that up to 20% of adult cancer survivors may develop heart problems due to cardiotoxicity from their cancer treatments.

"We're increasingly noticing, especially in younger patients who have many years of life left if cured, who then experience complications of the medical treatments we gave to [treat] them," said Brant Inman, a surgeon who focuses on bladder, kidney, and testicular cancers at the Schulich School of Medicine & Dentistry, Western University in Canada.

Anne Blaes, a professor of hematology and oncology at the University of Minnesota, noted that new cancer treatments may also lead to new long-term side effects. "Among the many new therapies, there's a growing concern about [the after effects] immunotherapy and what this does to atherosclerosis," a condition that thickens or hardens the arteries, she said. "We simply don't know yet."

Can you reduce your cardiovascular risks after cancer?

According to the Cardiovascular Risk Calculator, which was developed by the Childhood Cancer Survivor Study, cancer survivors who are at the greatest risk of heart issues later in life are:

• People aged 60 and older, young children, and women
• People who were treated with high doses of anthracyclines, high-dose radiation to the chest, or both
• People who have a history of smoking, high blood pressure, diabetes, obesity, or heart problems

To reduce the risk of potential heart problems after cancer treatment, Blaes recommends patients develop an individual plan tailored to their specific circumstances.

For example, many cancer treatment clinics have survivorship programs that can help create care plans. Another option is Oncolink, an organization that can create a personal care plan at no charge as long as patients know their previous treatment history. For more detailed and customized information about specific cancer treatments and heart disease, Blaes recommends using the American College of Cardiology's Cardiosmart tool.

Patients should also make sure doctors know their medical history and risk factors, including blood pressure, glucose and cholesterol levels, chronic inflammation, and more. Certain health conditions, such as high blood pressure, can significantly increase the risk of cardiovascular incidents after exposure to cancer treatments, and patients' primary care doctors should be aware of that, Blaes said.

Ultimately, "until less toxic cancer treatments are developed, this article only emphasizes the importance of quality survivorship and support services, since lifestyle interventions are one of the main ways that cancer survivors can minimize the damaging effects that their life-saving treatments may have had on their long-term health," said Advisory Board's Julia Elder.

To learn more about how providers can meet the unique needs of cancer survivors, check out our survivorship resource library.

Advisory Board also has resources that highlight how health systems are addressing the needs of patients who require both oncological and cardiovascular services. This expert insight outlines how two health systems are reimagining cardio-oncology care, while these two case studies provide specific examples of cardio-oncology programs. (Petrow, Washington Post, 3/24)

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