Connection between heart disease and cancer treatment

Benita Burke, M.D., Medical Director, Heart Care for Women, and Eleonora Teplinsky, M.D., Head, Breast Medical Oncology, Valley-Mount Sinai Comprehensive Cancer Care

Advances in cancer treatment have resulted in a growing number of cancer survivors. However, powerful treatments such as chemotherapy, radiation treatments and some cancer drugs are not without their risks, including the potential for serious, long-term damage to the heart. To mitigate these risks, specialists from cardiology and oncology often collaborate when treating cancer patients. This joining of clinical forces is known as cardio-oncology.

The field of cardio-oncology formed in response to both the increasing number of cancer survivors and the critical need for clinicians to consider the chronic and long-term adverse effects of treatment on patients. For example, heart failure-;developing during or after completion of cancer treatment-;is a well-recognized complication that can impact a patient's survival and quality of life. Studies have also shown that cancer survivors have a higher risk of cardiovascular disease (CVD) and death due to CVD in all age groups and are more likely to have traditional CVD risk factors compared with age-matched controls. In fact, individual cardiovascular risk factors like hypertension in a cancer survivor appear to carry greater risk than hypertension in an individual without a history of cancer.

With this research in mind, the main goals of cardio-oncology are to screen for and actively manage modifiable cardiovascular risk factors in cancer patients. For patients determined to be at high risk for developing heart disease, it is critical to implement strategies that focus on early detection of cardiotoxicity, or damage to the heart. These strategies can include:

• Referral to a cardio-oncologist as early as possible after diagnosis
• Obtaining an echocardiogram -; a diagnostic cardiac ultrasound -; before beginning treatment for cancer
• Routinely assessing patients for clinical signs and symptoms that raise concerns about possible cardiac dysfunction

A cancer patient's clinical team should regularly evaluate and manage any cardiovascular risk factors. A heart-healthy lifestyle should be discussed as a part of long-term follow-up care. Fortunately, following a heart-healthy lifestyle doesn't require hours of grueling exercise or giving up all of your favorite foods. A few simple lifestyle changes, such as the ones listed below, can make all the difference.

• Exercise 30 to 60 minutes a day on most days of the week. This can be as simple as taking a daily walk.
• Maintain a healthy weight.
• Quit or don't start smoking.
• Eat a diet rich in fruits, vegetables, whole grains, nuts and legumes, limiting highly refined carbohydrates and saturated fats.

If you are currently undergoing cancer treatment, be sure to ask your oncologist if you are receiving any therapies that could affect your heart now or in the future. And, if you have a history of receiving cancer-treating radiation to the chest, it is important to know if that raises your risk for heart disease.

The Cardio-Oncology Program at Valley–Mount Sinai Comprehensive Cancer Care brings together Valley Medical Group's cardiologists and oncologists in an integrated effort to provide specialized care and to protect heart health throughout cancer treatment. Valley's cardio-oncology team stays up to date with the latest advancements in cancer and cardiac care in order to better understand the connection between heart disease and cancer, develop more effective treatments with fewer side effects and improve patients' quality of life.