While radiation therapy and chemotherapy are helping more and more people to survive cancer, these treatments are often detrimental in another area: Cardiovascular conditions. Radiation therapy can be the cause of a heart attack, heart failure, and/or arrhythmias. Traditional and novel chemotherapy agents can damage the heart or peripheral blood vessels as well as cause problems with clotting or blood lipids.
There is now an emerging field of cardio-oncology with experts that are able to treat these patients in a muli-disciplinary approach. While some of these problems can be seen immediately, others may not be seen until long after treatment for cancer is gone. As Lori Minasian, M.D., deputy director of NCI’s Division of Cancer Prevention, explains, “Patients diagnosed with cancer are living longer today than in the past, and many of these survivors are living long enough to develop late cardiovascular effects.”
Due to these heart conditions, it is critical to hone in on the cardiovascular toxicities from cancer drugs. The cardio-oncology speciality combines the knowledge of cardiologists and oncologists to help protect the hearts of people undergoing cancer treatment. There are now a number of programs throughout the country and growing. As Dr. Mandeep R. Mehra, the executive director of the Center for Advanced Heart Disease at Brigham and Women’s Hospital and a professor at Harvard Medical School, explains “Being followed by a highly specialized cardiologist can benefit most people with cancer, but it is particularly important for someone who is at risk for heart disease or who already has heart disease.” It is imperative to look deeper into the cardio-oncology bond and learn more about the effects of anticancer agents on the heart and cardiovascular system.
Understanding the science of the relationship between cancer treatment and the heart is not an easy feat and is one that will take time to understand. This is why Dr. Mehra and his cardio-oncology colleagues Dr. Anju Nohria and Dr. Javid Moslehi at Brigham and Women’s, along with oncologists at the Dana-Farber Cancer Center, are taking part in it, each one with its unique role. While the oncologists test anticancer agents in clinical trials, the scientists are investigating the effects of these agents on the heart before the agents are released for widespread use, and the cardio-oncologists are searching for ways to counteract these effects.
While understanding the cardiovascular and cancer treatment relationship cannot be completely changed overnight, understanding the disease state of a patient’s heart and the immediate and long-term relationship between medication for treating cancer and cardiovascular conditions is of the utmost necessity. Before the patient begins cancer treatment, they must be tested appropriately for cardiovascular conditions and assessed for common risk factors. Preventative efforts once again are more important than cure.
Studies are still ongoing with much more information yet to be discovered. Decisions about how to test and monitor these patients are being evaluated, but testing and monitoring for pre-existing heart conditions and most importantly assessing risk factors can truly save lives.