Detecting – and Preventing – Heart Disease in Cancer Patients

December 14, 2016 | by City of Hope

saro armenian 256x256 City of Hope’s Saro Armenian, D.O., M.P.H., oncologist and associate professor in the departments of Pediatrics and Population Sciences

As new treatments and therapies for cancer emerge, the survival rate for patients continues to improve.

But treatment takes its toll on the body, and doctors often find themselves in an unenviable position: trying to prevent the cure for one disease from causing another.

Heart disease is one of the more common byproducts of chemotherapy or radiation, particularly if the patient is predisposed due to lifestyle or family history.  

Screening for heart disease among at-risk patients allows physicians to manage any cardiovascular problems associated with receiving chemotherapy.

This, according to a new guideline recommended by the American Society of Clinical Oncologists (ASCO), is based on the research and findings of an international team co-chaired by City of Hope’s Saro Armenian, D.O., M.P.H., oncologist and associate professor in the departments of Pediatrics and Population Sciences.

“There is a serious risk of cardiac complications in patients undergoing chemotherapy that can interfere with the delivery of much needed cancer-directed therapy and affect the long-term health of the cancer survivor,” Armenian explained. “To date, there have been no evidence-based recommendations on how to identify cancer patients at high risk for heart disease, or for early screening and prevention strategies to lower the likelihood of heart disease in cancer patients.”

The guideline, entitled, “Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers,” was published this month. It’s the only paper of its kind to have been endorsed by both oncology (ASCO) and cardiology (American Heart Association) organizations, and provides clear recommendations for monitoring at-risk patients.

Key recommendations include:

  • The “aging” of the heart is greatly accelerated in patients who have received certain cardiotoxic cancer therapies. Clinicians should avoid or minimize the use of potentially cardiotoxic therapies if established alternatives exist.
  • Before beginning a cancer treatment that may be harmful to the heart, clinicians should perform a comprehensive workup that includes medical history, a physical and screening for heart health.
  • Doctors should discuss the potential for heart problems with patients identified as being at risk.
  • A tailored and detailed plan should be developed to monitor and manage heart problems in the patients. 

Risk for heart dysfunction is assessed by taking into account the patient’s age, family history, pre-existing health conditions, the type of chemotherapy or chest radiation they are to receive, and the dosage.  

“Clear communication about warning signs and symptoms, as well as appropriate monitoring, can reduce the risk of heart complications,” Armenian said. “Doctors should also discuss heart-healthy lifestyles – including the role of diet and exercise – with all patients, before, during and after cancer therapy.”

The complete guideline and supplemental tools can be found here.

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