Cancer treatments- Radiation therapy and chemotherapy are raising the number of people who survive cancer. Though, they can also cause various health issues, including cardiovascular disease.
The heart conditions are the side effects, which develop after cancer treatments are upsetting. Heart muscles start becoming weak soon after the beginning of chemotherapy with some chemotherapy agents.
There are only some treatments of cancer that are associated with heart conditions. There are certain ways that can help to prevent or manage such side effects.
Heart problems are among the uncommon side effects of certain cancer therapies. However, they are very serious. The heart problems can:
- Affect the treatment
- Affect patient’s quality of life
- Cause death, rarely
In this blog we will discuss the link between heart problems and cancer treatment. To clarify this link we will discuss:
- Types of heart problems caused by cancer treatment
- Cancer treatments susceptible to cause heart problems
- Risk factors for heart problems associated with cancer treatment
- Preventing and managing heart problems arising due to cancer treatment
Types of heart problems caused by cancer treatment
People suffering from heart conditions may experience:
- Shortness of breath
- Chest pain
- Swelling in hands and/or feet
You must contact your doctor immediately if you notice any of these symptoms.
Following are some of the heart problems, which can develop after cancer therapy:
- Congestive heart failure: This condition causes damage to the heart, which makes it unable to pump blood properly.
ü Myocarditis: It is the heart swelling, which can have an effect on the heart beat.
- Coronary artery disease: This type of heart disease causes the scarring or blockage of the heart blood vessels.
ü Arrhythmia: It is the condition where there is an irregular heartbeat.
- Damage to heart valves: In this condition the valves become narrow and stiff or leak.
- Pericardium problems: Pericardium is the outer membrane of the heart. The problems associated with pericardium may include swelling or scarring or thickening of pericardium.
Cancer treatments susceptible to cause heart problems
Heart problems can be caused due to following cancer treatments:
- Chemotherapy using anthracyclines such as daunorubicin, doxorubicin and idarubicin: Anthracyclines are commonly used for the therapy of many solid and liquid tumours. Their mechanism of action involves the production of reactive oxygen species as well as DNA intercalation to damage protein synthesis and blockage of topoisomerase II, hindering DNA repair.
In comparison to topoisomerase II-alpha that is positioned on quickly dividing cells, topoisomerase II-beta, which is located on cardiac myocytes, is the expected mechanism behind the cardiotoxicity.
- Radiation therapy to the chest: Certain types of targeted treatment, including bevacizumab, trastuzumab, lapatinib and sunitinib.
Radiation therapy causes the DNA fragmentation, thereby hindering the cell reproduction and viability, mostly affecting the rapidly dividing cancer cells.
Radiation to the chest at high doses can impact the cardiovascular system. However, the toxicity generally becomes evident years after the exposure. Risk factors with radiation therapy for cardiovascular injury include coexisting cardiovascular risk factors, higher doses, younger age at time of irradiation and longer intervals from the time of radiation.
Risk factors for heart problems associated with cancer treatment
Following people may have a higher risk of developing heart problems due to cancer treatment:
- People 60 years of age and above.
- Young children and women
- People who received anthracyclines (high doses)
- People who received radiation therapy to the chest (high-dose)
- People who received combination of radiation therapy to the chest and anthracyclines
- People who had anthracyclines or trastuzumab treatment and hold a history of obesity, smoking, heart problems, high blood pressure and diabetes
- People who had treatment with anthracyclines followed by trastuzumab
Doctors will consider risks before recommending cancer treatments to you. Your treatment will be recommended based on you’re:
- Physical exam
- Other tests
- Your health history discussion
Preventing and managing heart problems arising due to cancer treatment
Your doctor may help you to decrease the risk of heart problems developing due to cancer treatment by recommending following options:
- Giving different medicine: Heart problems are not caused by all the drugs. Your doctor may give you equally efficient drugs, which are not associated with heart problems.
- Decreasing the dose or giving medicine in a different way: Your doctor may give you a low dose, which will still be effective to treat cancer but is less expected to affect the heart. Otherwise, you may be recommended a different method for receiving the drug, which is less damaging to the heart.
- Giving extra medicines, this can help in protecting the heart: Dexarazoxane is a drug, which can help in preventing the heart problems developing due to anthracyclines.
- Decreasing radiation treatment to the heart: It is possible using a low dose. Other techniques that may help are:
- Deep inspiration breath holding: This technique helps to avoid the unnecessary exposure of the heart to the radiation. In this technique, a deep breath is taken and held for short periods during the administration of radiation therapy.
- Intensity modulated radiation therapy: In this type of radiation therapy, the radiation dose is directed at the tumor by changing the intensity of the beam.
If a person develops heart condition after cancer therapy, then the doctor may recommend some medicines to manage it. These medicines may include one or more of the following:
- Blood pressure medications
Patients suffering with heart disease are at increased risk for worse results after the cancer treatment. Most frightening is the possibility for heart failure due to cancer therapy. This can result in early trouble or withdrawal of cancer treatments, which can cause increase in cardiovascular mortality.
But the association between heart problems developed due to cancer treatment is multifaceted and numerous cross-talk are required to clarify. The continuous studies in these fields will help to better understand and treat both lethal diseases.