Avoiding heart disease should be considered during breast cancer treatments
Feb 02, 2018, 21:10
Chemotherapeutic agents (eg, anthracyclines, alkylating agents, taxanes, and antimetabolite drugs), endocrine therapies, HER2-targeted therapies (eg, trastuzumab, pertuzumab), novel emerging therapies, and radiotherapy are associated with increased incidence of many cardiovascular diseases including left ventricular dysfunction (LVD), arrhythmias, conduction abnormalities, heart failure, thrombosis, and cardiomyopathy.
"There has to be a team approach to the care-not only the oncologists who are doing, I think, a fabulous job with breast cancer but also the cardiologist", Dr. Pina said, "so that the heart can be monitored, the patient can be advised about what can happen with some of the medications, and that we can treat them".
The study involved 2,168 women who underwent radiotherapy for breast cancer between 1958 and 2001.
Science is still working on combating the negative effects cancer treatment can have on patients' hearts, but drugs that can reduce cellular damage are being slowly introduced to the medical market. As a result, early development of heart failure can indicate the need to either slow a patient's treatment, or change to a different therapy to reduce the risk for worsening the condition or the development of permanent heart failure.
The problems can occur in patients with healthy hearts going into treatment.
Radiation therapy can affect blood vessels in ways that make patients more likely to develop coronary artery disease.
The anthracycline class of chemotherapeutic drugs can trigger abnormal heart rhythms, which may be benign or potentially life-threatening. Despite improvements in technology and delivery techniques, "irradiation to smaller volumes of the heart results in cardiac perfusion defects", the AHA panel stated.
However, new figures reveal that 11,819 men died in the United Kingdom from prostate cancer in 2015, overtaking breast cancer, which resulted in the deaths of 11,442 women.
Although deaths from prostate cancer have been rising over the past 10 years or so, the mortality rate or the proportion of men dying from the disease has fallen - by 6% - between 2010 and 2015.
The American Society of Clinical Oncology also now has guidelines in place for oncologists to consider regarding chemotherapy drugs and heart health, Rhee said. As much as 80% of attributable risk for CVD can be eliminated by attention to modifiable risk factors, including a healthy diet, abstinence from tobacco, maintenance of a healthy weight, blood pressure control, a favorable lipid profile, diabetes management, and physical activity.
Still, Mehta and co-authors said, doctors and patients alike need to recognize the importance of monitoring cardiovascular health throughout the process of cancer treatment to avoid any unexpected complications. In fact, older breast cancer patients more often die of heart disease than cancer itself. She said that a breast cancer patient who goes through chemo for three or four months loses 30 percent of her fitness, gains 10 pounds and ages the equivalent of 20 years.
This compares with 11,442 women who die from breast cancer. It is important to recognize the overlap of heart disease and breast cancer as both entities impact survival. So what should women do when they hear that some chemotherapy is toxic to heart cells?
Mehta disclosed no relevant relationships with industry.
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