The Cardio-Oncology Program at Dignity Health – Cancer Institute at St. Joseph’s Hospital and Medical Center serves to prevent, manage and possibly reverse the cardiotoxicity effects that can occur both during and after cancer treatment. Our cooperative approach between cardiologist and oncologist in one location is essential for early detection and prompt treatment.
As patients with cancer have been living longer, what are called “cardiotoxicities”—risky health effects on the circulatory system—have increased. Investigators from the fields of oncology and cardiology have come together to investigate the biology of these effects and search for ways to prevent, manage and possibly reverse them.
Minimizing cardiovascular risk factors for cancer patients
We closely monitor patients who are receiving chemotherapy that can affect the heart by both a thorough clinical assessment and a specialized echocardiogram every three months to detect any early changes in the heart function.
The American Heart Association reports that doctors sometimes use an “ABCDE” approach to reducing risk for cardiotoxicity and diagnosing the problem. The “A” stands for awareness: the realization that some cancer treatments, including those for breast cancer, can increase the risk for heart disease. “A” can also stand for aspirin, which taken once daily decreases the risk of heart attack or stroke in specific patients.
“B” is for blood pressure: it’s advisable to aggressively manage blood pressure and keep it below 140/90 or below 130/80 if the patient has diabetes. “C” is for cholesterol: every breast cancer survivor must have cholesterol levels checked every five years. High cholesterol needs to be treated with lifestyle intervention or medications. “C” also refers to cigarette smoking cessation. Tobacco smoke is the leading cause of heart disease.
“D” is for diet and diabetes: The Mediterranean diet has been shown to reduce the incidence of heart disease in high-risk patients. Diabetes mellitus or high blood sugar is a significant cause of not only coronary heart disease but also stroke and kidney disease. Every breast cancer survivor should undergo screening for diabetes mellitus. “D” also stands for dose of radiation or chemotherapy. Some of the heart and vascular effects of chemotherapy and radiation are dose-related. The unique relationship between our cardiologist and cancer physicians at the Dignity Health – Cancer Institute at St. Joseph’s allows for more precise treatment plans in consideration of cardiovascular affects.
Finally, “E” stands for exercise and echocardiogram. Lack of regular physical activity is an important risk factor for heart disease. Physical activity has many benefits, including lowering your blood pressure, helping you lose weight, lowering your cholesterol levels and reducing your risk of developing diabetes. Breast cancer survivors who received certain chemotherapies, including anthracyclines, should be considered for an echocardiogram (ultrasound of the heart) after completion of chemotherapy to look for structural changes in the heart. An echocardiogram uses ultrasound waves and carries no additional radiation risk to the patient.
Who receives care for cardiotoxicities?
According to the National Comprehensive Cancer Network (NCCN), patients who are older; young children; and women have a greater risk for cardiotoxicity. In addition, patients who have other health conditions at the same time as cancer are at increased risk. This is especially true for patients with signs of heart trouble before cancer.
When heart damage has occurred
If treatment for cardiotoxicity is started early, it is more likely that serious heart damage will be prevented. If you develop heart failure or another problem as a result of cancer treatment, you will be treated like other patients with those conditions. Treatment for heart failure, for example, may include:
- a diuretic (to control your fluids),
- an ACE inhibitor (to control your blood pressure),
- a beta-blocker (to control your blood pressure), or
- a digitalis drug (to make your heart stronger and to regulate heart rhythm).
Clearly, the optimal approach is prevention of cardiotoxicity. Before you begin any treatment for cancer, ask your doctor these questions:
- Do the treatments you are suggesting cause cardiac toxicity?
- What type of heart damage may occur?
- Are there safer treatments or treatment schedules we can use?
- Would these safer choices affect how well my cancer is treated?
- Is dexrazoxane (deks-ray-ZOKS-ane) appropriate for me? (If receiving breast cancer treatment.)
- How and how often will my heart be checked for problems?
- Are there any clinical trials that I can join?
For more information about cardiotoxicity or to schedule an appointment with a cardio-oncology specialist, please call (602) 406-8222.