Diagnosed with cancer is major. Doctors sit with the patient going over all the types of treatments, chemotherapies, radiotherapies or radiation and surgical procedures. Often side effects of these treatments are barely touched upon, especially the long-term side effects.
“Remission” is a word most cancer patients aim for, and if achieved are elated. But what about the long-term side effect? How often are they discussed? Some nurses or doctors will say, the patient was so excited, we left that discussion for a later time. Sometimes that discussion does not come.
Cardiovascular side effects after chemotherapy treatments are far more common than doctors will tell you. Chemotherapy agents can cause blood clotting or pose problems for blood lipids; damage to the heart muscle or blood vessels can occur. Many effects are evident while chemotherapy is given, others will not occur until months or years later.
One example is a young lady that had chemotherapy at a young age for leukemia, told her chances of having a normal pregnancy would not be good she was surprised to find out she was pregnant, but the biggest surprise was when she found out she had heart damage that almost took her life while pregnant.
Another is a woman [Campos] was told by her doctors she had months to live after discovery her shortness of breath and loss of energy was due to heart failure brought on by her chemotherapy treatments years before for her breast cancer. Although she survived thus far from cancer her prognosis was grim but seeking a doctor that finally found drugs to manage her heart condition she has more hope.
These examples are not isolated. Many never know their heart conditions are due to past chemotherapy or radiation treatments. Some die without ever realizing the damage existed. Drs. Mehra, Moslehi, and Norhria believe evaluating individuals with echocardiography, electrocardiography and certain biomarkers may identify symptoms before trouble begins and irreversible heart damage occurs; physical exams and multigated acquisition scans [ MUGA] may be performed. Some damage they have found can be reversed; Dr. Moslehi reported cardiomyopathy from angiogenesis inhibitors can be reversed using medications commonly used. British researchers have been able to prevent heart failure in patients using trastuzumab [Herceptin] using beta blockers. Usually, patients taking trastuzumab are checked by a cardiologist using an echocardiograph and followed up but not all doctors do this letting many patients slip through without proper monitoring.
Patients should be encouraged to follow guidelines to reduce the risk of Cardiovascular problems. Those treated as children with lymphoma and leukemia should be aware of the risk, although there are reports radiotherapy induced heart failure is rare, monitoring is highly recommended.
Because of these growing advances in drug treatments and radiation therapies, to limit the impact of cardiovascular side effects, a need for Cardio-Oncology has immersed. Treating and recognizing cardiotoxicity during and before treatment is needed. These steps hopefully will minimize the morbidity and mortality in cancer patients being treated with cardiotoxic type agents. The aim is to improve the survival rates of such patients. Radiation therapy can be just as toxic as chemo drugs, causing heart attacks, heart failure, and arrhythmias.
Dr. Mandeep Mehra, executive director of the Center for Advanced Heart Disease at Brigham and Woman’s Hospital and a professor at Harvard Medical School reportedly said, “Almost every chemotherapy drug has some effect on the cardiovascular system, and most are not good. But with the new anticancer agents, an increasing amount of cardiac toxicity is being observed.”
The side effects are serious, and certainly life-threatening in many cases. Some chemotherapy agents cause weakening of the heart muscle [often soon after taking the drug]; novel angiogenesis inhibitors suppressing new blood vessel formation cause high blood pressure and increase the risk of blood clots and heart failure. [ Heart failure is a progressive condition in which the heart is unable to pump blood efficiently to meet the body’s needs] Hormone therapies are causing strokes, heart attacks, and blood clots. They are observing ischemia, arrhythmias, and inflammation around the heart.
The American Heart Association has warned breast cancer survivors treated with chemotherapies and radiation therapies, they are at an increased risk for heart failure and other cardiovascular diseases. The urged doctors to weigh the use of using cardiotoxic chemotherapies against the risks posed to the heart. How many will? Much of this information has been known for nearly a decade and still, the discussion of these risks are not mainstream dialogue with oncologists.
If you are having any type of toxic cancer therapy, know the impact it will have on your heart.
Some treatments cause temporary heart damage, with medication it can be reversed. These treatments include drugs known as anthracyclines such as doxorubicin, daunorubicin, and others. Chemotherapy medications, such as taxanes, can cause an abnormal heart rhythm. These effects usually occur during treatment, it is important patients are told to look for such things as lightheadedness or feeling faint treatment can be discontinued. Fluorouracil and capecitabine [Xeloda] can cause spasming of the coronary arteries and may bring on a heart attack. Once the drug is discontinued the condition should reverse. Shortness of breath, chest pains while taking either of these drugs may be an earlier sign of heart problems, a doctor or emergency room should be notified or visited.
Most often heart damage is related to a cumulative amount of chemotherapy drugs. These drugs include: anthracycline drugs, Doxorubicin (Adriamycin) or daunorubicin (Cerubidine, daunomycin) [most likely to cause heart damage], Epirubicin (Pharmorubicin) and idarubicin (Idamycin) [may also cause heart damage], mitoxantrone (Novantrone), paclitaxel (Taxol), cyclophosphamide (Cytoxan, Procytox), trastuzumab (Herceptin) [trastuzumab [Herceptin] and pertuzumab [Perjeta] that are used for breast cancer to attack HER2 protein cause heart damage that is long-lasting and permanent].
Common heart conditions associated with these drugs include:
Congestive heart failure (CHF)—weakening of the heart muscle. People with CHF may experience shortness of breath, dizziness, and swollen hands or feet.
Coronary artery disease—heart disease. This condition is more common in those who had high doses of radiation therapy to the chest. People who have heart disease may experience chest pain or shortness of breath.
Arrhythmia—irregular heartbeat. People who have an arrhythmia may experience lightheadedness, chest pain, and shortness of breath.
The drugs causing the most heart problems are Trastuzumab, Doxorubicin, Daunorubicin (Cerubidine), Epirubicin (Ellence), Cyclophosphamide (Neosar).
The most commonly known chemotherapy drugs with cardiotoxic agents list: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258909/table/T1/
Who is at risk? Anyone that is taking any of the listed drugs that are cardiotoxic or have used radiation therapy. Those that have had such treatment in early childhood or adulthood have many years for the damage to develop into a problem. If you have previously had radiation therapy and now are exposed to further such treatments due to a newly diagnosed cancer or recurrence, this new treatment will put you into a higher risk bracket.
Cardiotoxicity depends on certain factors: the type of drug, the dosage administered, the cumulative doses, combinations of other cardiotoxic drugs or radiation as well as the patient’s age, prior or present cardiovascular health. The below list is a summary of adverse cardiotoxic effects induced by chemotherapy.
Cardiovascular toxicity of chemotherapeutic agents
|Drugs associated with CHF||Anthracyclines/anthraquinones|
|Trastuzumab and other monoclonal antibody-based tyrosine kinase inhibitors|
|Drugs associated with ischemia or thromboembolism||Antimetabolites (fluorouracil, capecitabine)|
|Antimicrotubule agents (paclitaxel, docetaxel)|
|Drugs associated with hypertension||Bevacizumab|
|Drugs associated with other toxic effects|
|Tamponade and endomyocardial fibrosis||Busulfan|
|Haemorrhagic myocarditis (rare)||Cyclophosphamide (high-dose therapy)|
|Raynaud’s phenomenon||Vinblastine, bleomycin|
|QT prolongation or torsades de pointes||Arsenic trioxide|
|Pulmonary fibrosis||Bleomycin, methotrexate, busulfan, high- dose cyclophosphamide|
The curiosity of: Oxford Academic Annals of Oncology
Risk of heart failure increases with increasing radiation dose on the cardiac structure.
Anthracyclines including doxorubicin can kill cardiomyocytes, that make up the heart muscle causing an increased risk of heart failure by 3-fold independently of radiation dose. , it has been shown that the longer the follow-up, the higher the incidence of cardiac dysfunction.
Hormone-based drugs like Tamoxifen can potentially cause fatal thromboembolism or blood clots.
Taxanes like paclitaxel can cause abnormally slow heart rhythm.
Aromatase inhibitor anastrozole is linked to heart attacks along with other cardiovascular issues.
Trastuzumab [Herceptin] is recorded as causing heart failure, this is especially true for women over 50 or those with prior heart disease.
Treating cancer may be no small task but treating it only to cause irreversible damage to the heart while trying to shrink cancer may not be the wisest course of action. It is increasingly evident that the focus is not on curing without doing harm but to treat with no regard to after effects causing much harm. The answer always is the benefits outweigh the risks. Yet is the risk of death from a heart attack, not a risk too high to take for most? These risks are not commonly spoken about between patients and their doctors. As serious as these risks are why do doctors fail to tell patients?
More and more individuals facing the diagnosis of cancer are opting for do-no-harm treatments, leaving chemotherapy and radiation behind. Some thinking immunotherapy is a do-no-harm treatment soon discover, yet again, the doctors have lied to them. Immunotherapy drugs act much like chemotherapy drugs in that they have the same type of side effects. Perhaps it’s another way pharmaceutical corporations are marketing as more people try to move away from chemotherapy, but a rose by any other name is still a rose. It’s time for us to turn a major diagnosis into a do-no-harm cure.
Jesicha’s Hope understands this topic. It’s founder died of heart failure brought on by chemotherapy and radiation treatments. She was never told either could harm her. We continue our quest to discover the truths and find curative treatments around the globe. Visit us at www.jesichashope.org – or our Facebook page: www.facebook.com/jesichashope, join our group: www.facebook.com/groups/alternativecancertreatments or contact us directly: email@example.com
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