Patients & Caregivers

What You Need to Know About Cardio-Oncology

Navigating a new heart condition caused by cancer treatment can be daunting. Use this guide as a starting point.

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Cardio-Oncology is Vital for Patients with Cancer

Cancer treatments have advanced to improve life expectancy and quality of life. However, sometimes, these life-saving remedies can cause heart problems during and after treatment. Heart problems are usually minor, and can usually be managed with screening and treatment, but at times can be more severe.

These problems can also arise during treatment but also years later, once treatment is over. That is why annual heart and medical checkups are important.

What do Patients Need to Know About Treatments That Can Affect the Heart?

It is important to remember that the therapies below are excellent at treating cancer. While they may potentially affect the heart, the overall risks are usually low. Examples of treatments that may affect the heart are:

Radiation may affect the blood vessels and/or heart in the area receiving radiation.
HER2 antagonists (including Herceptin/trastuzumab) and anthracyclines (including doxorubicin, epirubicin, and daunorubicin) can affect the strength of the heart muscle.
Hormonal agents (agents that affect estrogen or testosterone levels) can affect the risk of developing clots and increase blood pressure or cholesterol.
Immunotherapy works by turning your immune system against cancer. Rarely the immune system can also be activated against the heart.
Some cancer treatments are referred to as “targeted therapy” which directs against specific receptors or proteins in the body. Depending on the receptors or proteins involved, treatments may affect the heart and vascular system. Agents that target the body’s “VEGF” (Vascular endothelial growth factor) system can increase blood pressure, for example.
Stem Cell (or Bone Marrow) transplantation increases the risk of atrial fibrillation and may also cause stiffening, and sometimes some weakening, of the heart muscle.

There are recommended cardiology screening tests and preventive medications that can help patients at risk to help prevent heart issues.

Are Childhood Cancer Survivors at Risk, too?

Childhood cancer survivors, especially those who have received an anthracycline or radiation to the chest, are 10-20% more likely to have cardiac issues in their 30s and 40s (almost unheard of in the adult population) as compared to others in their age groups and siblings. The longer they live, the more susceptible they are to getting premature heart disease, or heart and blood vessel disease.

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Symptoms to Lookout for During Treatment

Shortness of Breath
at rest or with activity

Increased Fatigue

Increased Swelling
of your legs or your belly

Irregular Heartbeat or Racing of Your Heart

Chest Pressure and/or Pain
with activity

If I have symptoms, how will this affect my cancer treatment?

Cardio-Oncology providers aim for prevention and seek to address any heart concerns quickly and as early as possible to continue your cancer treatment. Most of the time, your team can address any heart concerns while maintaining the beneficial effects of your cancer therapy. The earlier you alert your providers, the better.

These symptoms can have different causes, but you should get a further evaluation to ensure your heart is still functioning well. While some symptoms are more likely to start during treatment, some may not start until years or even decades after treatment. If you have any questions, please let your providers know right away.

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How Can I Help Myself?

What do patients need to do if they already have heart issues?

Please let your healthcare providers know before starting treatment. Your treatment team can ensure you are on the appropriate medications to reduce further risk of cardiology problems in the future.

Stay Hydrated

During your cancer treatment, it is certainly important to stay nourished and hydrated, even if you have to vary some from recommended heart diets.

Eat Right

Healthy eating is important for long term heart health, such as the Mediterranean diet, “DASH “ (Dietary Approaches to Stop Hypertension), a plant-based diet, or other healthy eating plans. These plans include more fruits and vegetables and reduce red meat and saturated fats.

Limit Salt Intake

In combination with the diets listed, reducing salt reduces risk for heart disease and lowers blood pressure.

Get Active

Regular physical activity and exercise are always good for you and your heart. Be aware of your limitations when receiving cancer treatment because you may have to modify the extent of your exercise based on your energy level.

Get Some Sleep

Getting a good night sleep is important for your heart health and your overall health. Most adults need 7-9 hours of sleep for adequate rest. If you are having difficulties getting enough sleep, your provider may have some helpful tips.

Take Your Medication

Take prescribed medications and follow the recommended screening.

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Ask Questions

Advocate for yourself or your loved one by asking questions. Trust your gut and if you aren’t getting your questions answered, keep asking until you do.