Cardio-Oncology: An Evolving Aspect of Cancer Care
- Cardio-oncology is a growing field focused on the connection between cancer treatment and heart disease. It is especially important today because many powerful cancer treatments can affect the heart.
- Cardio-oncology helps patients receive the best possible cancer treatment while protecting long-term heart health. As cancer therapies become more effective, approaches to monitoring heart health must evolve as well.
- “Heart problems can happen, but they do not happen to everyone, and doctors are learning how to identify risk, monitor patients carefully, and treat problems earlier,” Dr. Javid Moslehi, a cardio-oncologist at UCSF, tells SurvivorNet.
- Cancer therapies like chemotherapy, radiation, targeted treatments, and immunotherapy, can all impact the heart. A cardio-oncologist helps oncologists deliver those therapies while identifying and managing cardiac risk.
Cardio-oncology is a growing field focused on the connection between cancer treatment and heart disease. It is especially important today because many powerful cancer treatments, including chemotherapy, radiation, targeted therapy, CAR T-cell therapy, and immunotherapy, can affect the heart.
Read MoreWhich Cancer Treatments Can Impact The Heart?
Cancer therapies are designed to kill cancer cells or stop them from growing. However, because cancer cells and healthy cells share some biological pathways, treatment can sometimes affect normal tissues too. This is where many of the most well-known side effects from chemotherapy stem from. Dr. Moslehi describes this as a kind of “friendly fire.”Different cancer treatments can affect the heart in different ways:
- Some traditional chemotherapy drugs, especially anthracyclines like doxorubicin, can weaken the heart muscle and increase the risk of heart failure. These drugs have been used for decades and remain important in cancer care, but their cardiac effects are well recognized.
- Radiation therapy can also affect the heart, particularly when radiation is delivered near the chest. In some patients, heart-related effects may appear years later and may involve the coronary arteries, heart valves, or other cardiac structures.
- Targeted therapies are designed to block specific cancer pathways, but sometimes those same pathways also help normal heart cells function. When that happens, targeted therapy may create cardiovascular risks depending on the specific drug and patient.
- Immunotherapy has introduced a different type of risk. These treatments activate the immune system to fight cancer. In rare cases, the immune system may also attack healthy organs, including the heart.
What To Know About Heart Toxicity
For patients, the possibility of heart problems can sound frightening, but Dr. Moslehi emphasizes that “most patients should not hear this information as a reason to avoid effective cancer treatment.”
Cancer therapies are prescribed because they may offer meaningful benefits. The role of the cardio-oncologist is to help oncologists deliver those therapies while identifying and managing cardiac risk.
In other words, the question is usually not whether treatment should be avoided due to risks for the heart, but “How can we give this treatment safely, monitor carefully, and intervene early if a problem appears?”
Some patients may need more intensive monitoring due to certain conditions, such as:
- Existing heart failure
- Coronary artery disease
- Abnormal heart function
- Multiple cardiovascular risk factors
Others may only need standard observation.
This is where personalized medicine becomes important. Risk is not the same for every patient, and toxicity is not the same for every drug.
Questions To Ask Your Doctor
- Are there any heart-related risks I should be aware of?
- Do I need a baseline heart test before starting cancer treatment?
- Does this treatment worsen hypertension?
- What symptoms should I be on the lookout for during treatment?
- How will my heart be monitored?
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