If you’re being treated for cancer, getting your disease into remission is probably your top health priority. But did you know that some cancer treatments may affect your heart? The good news is you can take steps to keep these side effects to a minimum.
If you have heart disease, it is important to work with a cardio-oncologist (a doctor who specializes in heart health during cancer treatment), to get the extra attention and careful treatment needed.
Cardio-oncologists support people who are at higher risk of developing heart problems during cancer treatments like surgery, radiation, chemotherapy and targeted antibody or immune therapies. That’s important because heart problems are the second most common cause of ongoing health problems or death in cancer survivors.
Farouk Mookadam, MD, a professor of cardiology and the cardio-oncology director at Banner MD Anderson Cancer Center, explained more about the heart problems cancer treatments may cause and the best ways to minimize them.
How cancer treatments can affect the heart
Cancer treatments are designed to target and get rid of cancer cells. But they may also affect healthy cells, including those in the heart. These effects can sometimes be serious and may require a change in the direction of cancer treatment.
“Chemotherapy, radiation treatments to the chest area, immunotherapy and antibody-targeted cancer treatments can affect the heart muscle, lining, valves, electrical system and blood vessels,” Dr. Mookadam said. “They can raise blood pressure and increase the risk of blood clots in the arteries and veins or cause congestive heart failure or cardiac arrhythmias.”
“Early detection of potential heart side effects and timely intervention are key to successfully treating these cancer patients,” Dr. Mookadam said.
Who is at risk?
Anyone who is being treated for cancer could be at higher risk for heart problems. But people in certain groups or with other health conditions may be at greater risk.
They include people who:
- Are ages over 65 or under 18
- Women, who are at higher risk than men
- Have high blood pressure, coronary artery disease or diabetes
- Need higher doses or longer treatment with chemotherapy
- Use tobacco and smoke
- Have a high body weight
- Don’t get enough physical activity
- Don’t manage stress well
“Somebody who may be overweight, sedentary and has high cholesterol, high blood pressure or diabetes would be at a much higher risk of heart complications when receiving cancer treatments than somebody who's younger, exercises and has a lean body mass,” Dr. Mookadam said.
Watch for these warning signs
The following symptoms could be a sign that your heart is getting weaker or damaged due to cancer treatment. However, they could be related to the underlying cancer or treatments as well, so diagnosis can sometimes be challenging. Watch for:
- Fatigue and weakness
- Shortness of breath or a feeling of being out of breath more than usual that requires you take frequent breaks to rest
- Swelling in the legs, ankles or abdomen or unexplained weight gain in a short time, which can be a sign of fluid retention
- Feeling more tired than usual with physical activity
- Chest pain, pressure or palpitations, especially when exerting yourself
- Shortness of breath when you lie on your back
Be sure to share any symptoms with your provider, even if they don’t seem important to you.
Getting care right away can help keep your heart as strong and healthy as possible. If you’re being treated for these symptoms and they’re still getting worse, contact your provider right away.
If you have chest pain, dizziness or a rapid or irregular heartbeat, call 911 or have someone take you to the emergency room. These may be signs of a serious problem with your heart.
Keeping an eye on your heart
Since cancer treatment can affect your heart, your oncology (cancer) and cardiology (heart) teams may monitor your heart during treatment. That way, they can spot problems early, before you notice any symptoms.
Echocardiograms, or heart ultrasounds, can look at your heart function. A feature called strain imaging or speckled track imaging monitors how the heart’s muscle cells contract and relax. It’s a good option for identifying problems early, so it’s used by many cardio-oncology teams.
“Early detection is huge,” Dr. Mookadam said. “If you detect an injury early on, you can repair the heart or minimize further damage. In fact, a lot of data shows that if you detect damage within the first two months, you can recover heart function 80% to 90% of the time.
How to protect your heart
You, your oncologist and your cardiologist can work closely together to come up with a plan for monitoring your heart health and addressing any issues that come up. Your providers might:
- Evaluate your heart before you start treatment to see how healthy it is.
- Encourage a healthier lifestyle by recommending a Mediterranean/pescatarian diet, regular exercise, weight loss, tobacco and alcohol cessation and careful blood pressure control.
- Prescribe medications that can help protect your heart.
- Monitor your heart function regularly during treatment.
- Adjust your chemotherapy doses or treatment schedule if needed.
“Oncologists and cardiologists work closely together during cancer treatment. Some cancers can be very aggressive, and we know treating them may cause some damage to the heart. Sometimes, we may even pause cancer treatment and focus on improving the heart before trying new treatments,” Dr. Mookadam said. “But with early detection and treatment for any heart problems, we rarely get to the point where you have to stop cancer treatment altogether.”
Lifestyle habits can help
Healthy habits can help keep your heart strong and make it less likely that you’ll have heart problems from your cancer treatment. “The things that cause cancer and the things that cause heart disease are almost identical,” Dr. Mookadam said. “By the same token, the same things that prevent heart disease can prevent cancer – the first line of treatment is prevention.”
Your provider may recommend:
- A heart-healthy diet like the Mediterranean diet that limits salt and saturated fats but is rich in fruits, vegetables, lean proteins and whole grains. Limiting salt is especially important if you have cardiomyopathy.
- Regular exercise: “It’s a challenge for people undergoing cancer treatment or those who have heart problems to exercise when they feel weak and tired,” Dr. Mookadam said. But any type of physical activity can be helpful. He recommends aiming for 40 minutes or more at least five days a week and points out that exercise helps the whole body combat the effects of cancer treatment, not just the heart.
- Stress management through techniques like mindfulness, meditation and relaxation exercises can promote emotional well-being and help improve heart health.
- Mental health support to cope with the emotional toll of cancer treatment. Counseling, support groups and mental health services can help.
Working with your providers
Building a strong partnership with your oncologist, cardiologist and other health care providers is an important part of your care plan. Be sure to talk about your concerns, share your symptoms and discuss your overall well-being.
Work together to develop treatment plans. Talk about your options and any side effects that could impact your heart and share your preferences. Ask about the heart assessments you might need before treatment starts and how your heart will be monitored going forward.
The bottom line
The treatments that help get rid of cancer may also impact the healthy parts of your body, including your heart. Keeping an eye on your heart, watching for symptoms, making lifestyle changes and adjusting your cancer treatments can all help your heart stay as healthy as possible when you’re being treated for cancer.
To learn more talk with your health care provider or reach out to an expert at Banner Health to learn more.