Cancer Treatment And Heart Health

Some cancer treatments can cause heart problems. Doctors cause heart problems caused by cancer treatment cardiotoxicity. Knowing which treatments can cause heart problems and what puts you at a higher risk can help you and your healthcare team make decisions about your care and follow-up treatment.

What is cardiotoxicity? 

Cardiotoxicity is damage to the heart caused by some types of chemotherapy, targeted therapy, or radiation. 

This damage can make it hard for the heart to function properly and can lead to:

• Cardiomyopathy (disease of the heart muscle)
• Heart attacks 
• Coronary artery disease
• Heart failure 
• Heart valve disease
• Irregular heart rhythms
• Fluid buildup around the heart 
• Changes in blood pressure 
• Slow heart rate
• Thickening of the heart’s lining

How chemotherapy affects the heart

Chemotherapy is used to treat many different types of cancer. They work by stopping the division and the growth of cancer cells. But when given at high doses, some types of chemotherapy can damage the heart. 

Anthracyclines are powerful chemotherapy drugs that can cause heart problems. They are used to treat many types of cancer, including:

• Acute lymphocytic lymphoma (ALL)
• Acute myeloid leukemia (AML)
• Bladder cancer
• Breast cancer
• Lymphoma
• Multiple myeloma
• Sarcoma
• How targeted therapies affect the heart

Targeted therapies like tyrosine kinase inhibitors block proteins and signals that help cancer cells survive. Although targeted therapies are more precise than chemotherapy and spare healthy cells, they can still lead to serious heart side effects. This is especially true if they are combined with other drugs that can damage the heart, like anthracyclines.  

How radiation therapies affect the heart

Radiation therapy is a type of treatment that uses high doses of radiation to destroy cancer cells. When radiation therapy is directed at the chest, it can affect heart tissue. 

Each of these treatments can lead to weakening of the heart muscle, rhythm changes, and hardening of arteries, raising the risk of heart failure.  

Because of the risk of damage to the heart, your care team will monitor your heart function throughout your treatment. 

Other risk factors for cardiotoxicity

In addition to some types of cancer treatments, there are several other factors that may increase your risk of developing cardiotoxicity, such as: 

• Age (being younger than 18 or older than 65)
• A history of heart problems
• High blood pressure
• Smoking tobacco
• Having high cholesterol
• Being overweight

What are the symptoms of heart problems?

Some signs and symptoms of heart problems include: 

• Abdominal (belly) enlargement
• Chest pain
• Dizziness
• Heart palpitations
• Shortness of breath
• Swelling in the legs

If you are experiencing any of these heart-related symptoms, it is important that you speak with a healthcare professional right away. 

How are heart problems prevented during cancer treatment? 

Before starting cancer treatment, your healthcare team will determine whether you are at a higher risk for cardiotoxicity. They may even refer you to see a cardiologist who can help determine the best treatment plan for you.

Depending on the treatment you receive and your risk of developing heart problems, your care team may recommend monitoring. 

How are heart problems treated during cancer treatment?

If you develop heart problems as a result of cancer treatment, you will need to work with a specialist to protect the health of your heart. Specialists who treat heart problems are called cardiologists. You may also work with a primary care physician and a registered dietitian, who can help you change your eating habits. 

The type of treatment you receive depends on the type of damage you have to your heart. It could include:

• Diet changes to focus on heart-healthy foods low in sodium and fat. 
• Other lifestyle changes, like regular exercise and stress management.
• Medications like statins, beta blockers, and diuretics. 
• Surgery to repair or replace damaged parts of the heart. 
• Devices to improve heart function that assist with circulation and keeping arteries open.

What researchers are learning about cardiotoxicity

Researchers are also exploring different ways to prevent or reduce heart problems caused by cancer treatment.

Guanylate-binding protein 5 (GBP5). GBP5 is a gene that supports immunity and helps protect against viruses. GBP5 “turns on” NLRP3, a protein that drives inflammation. After radiation, GBP5 increases, which can then cause chronic inflammation and damage to the heart.   Targeting and modifying the activity of GBP5 could reduce the inflammation that leads to cardiac damage. 

Newer classes of BTK inhibitors may cause fewer heart rhythm disorders. Bruton’s tyrosine kinase (BTK) inhibitors are a type of targeted therapy for blood cancer. The early BTK inhibitors, such as ibrutinib (Imbruvica), can cause heart problems like irregular heartbeat, high blood pressure, and abnormal heart rhythms.

The more selective or targeted a BTK inhibitor is, the less likely it is to cause damage to the heart.  Newer classes of BTK inhibitors like acalabrutinib (Brukinsa) work the same way as Ibrutinib (blocking the activity of BTK) but with fewer negative side effects to the heart.  

Understanding the different impacts that cancer treatments can have on your heart will help in creating a treatment plan that is best for you.  

Your providers will monitor your overall health and heart function and may lower or change your medication before or during cancer treatment to reduce your risk of developing heart damage. 

HealthTree can help you find side effect solutions

Understanding the side effects of blood cancer therapies can help patients know what to expect during treatment. It also helps researchers identify patterns and the risks that come with different treatments. This information can lead to safer treatments and better outcomes for people living with blood cancer. You can use our side effects solutions tool to share your experience or learn about the experiences of others.

Side Effects Solutions

Sources: 

• The ASCO Post-Investigating the Mechanisms of Cardiovascular Adverse Events Linked to Certain Cancer Treatments 
• ​Cleveland Clinic-Cardiotoxicity: Cancer Treatment and the Heart 
• American Heart Association-American Heart Month 
• Mayo Clinic-Atrial fibrillation
• MD Anderson Radiation Therapy