Cardio-oncology

Reviewed by Jessica Munoz DPN, RN, CEN

Cardio-oncology is an emerging specialty within cardiology focused on identifying, monitoring, and managing cardiovascular diseases that arise as side effects of radiotherapy or chemotherapy. Cardio-oncologists, who are essentially cardiologists, oversee the heart health of cancer survivors and patients currently undergoing cancer treatment. They are well-versed in the cardiac side effects associated with chemotherapy, targeted therapies, and radiation. Since this is a relatively new area in cardiology, many cities across the United States still lack dedicated cardio-oncologists.

Both chemotherapy and radiotherapy can lead to cardiac dysfunction, which significantly contributes to mortality and morbidity among cancer patients. Therefore, it is crucial to regularly monitor the cardiovascular health of patients undergoing cancer treatment.

Cardiotoxicity

Life-saving treatments such as chemotherapy and radiotherapy, while effective against cancer, can cause cardiovascular issues known as cardiotoxicity. This condition can manifest during cancer treatment, or it may appear days, months, or even years after the treatment has ended. Chemotherapy-induced cardiotoxicity can significantly reduce the quality of life and increase the risk of death due to cardiac complications.

Symptoms

Cancer treatments can impair the heart’s pumping efficiency, alter blood flow, and increase the risk of blood clots (thrombosis), potentially leading to a heart attack. Common heart conditions resulting from these changes include:

• Congestive Heart Failure: The most serious form of cardiotoxicity related to cancer treatment.
• Pericarditis: Inflammation of the heart muscle.
• Coronary Artery Disease

Other possible heart disorders due to cancer treatment include:

• High blood pressure (hypertension)
• Low blood pressure (hypotension)
• Valve disease
• Abnormal heartbeat (arrhythmia)

Types of cancer treatments that cause heart disease

Not all cancer treatments cause cardiotoxicity, but many have the potential to damage the heart, including:

• Drugs used to prevent cancer recurrence
• Radiation therapy to the chest area
• Certain chemotherapy drugs
• Targeted therapy (molecular therapy)
• Monoclonal antibodies

Who is at risk?

Individuals at higher risk for cardiotoxicity include those with preexisting heart disease or risk factors for heart disease, such as:

• Obesity
• High-fat diet
• Smoking
• Family history of heart disease
• Sedentary lifestyle

Certain chemotherapy drugs can damage heart muscles and blood vessels, increasing the risk of cardiotoxicity, especially in patients with underlying heart risk factors. Those undergoing radiation therapy in the chest area are also at higher risk due to the proximity of the heart to the radiation site.

Prevention

Patients scheduled to receive potentially cardiotoxic therapy should undergo a comprehensive physical and cardiac evaluation before beginning cancer treatment. This evaluation helps doctors identify those at risk for cardiotoxicity and take necessary measures to reduce the patient’s risk. The evaluation may include:

• Family medical history
• Personal medical history
• Echocardiography and measurement of global strain, used for assessing heart function
• Thorough cardiovascular physical examination

Global strain is a new measure of heart muscle function determined through echocardiography with specialized computer technology. It allows for a more precise assessment of changes in heart function due to potentially cardiotoxic treatments.

The duration of these changes is still uncertain; some may be reversible, while others could be permanent.

Treatment

Patients experiencing symptoms that may involve their heart should consult their oncologist or primary care doctor. Doctors can refer patients to a cardiologist or a cardio-oncologist if necessary. It’s important for patients to learn about potential side effects of cancer treatment so they can inform their healthcare team.

Patients showing symptoms of cardiotoxicity should visit a cardio-oncology center. These specialized centers involve a multidisciplinary group of specialists, including cardiologists, oncologists, cardiac surgeons, and nursing staff, who provide a comprehensive approach to diagnosing, evaluating, and treating cardiotoxicity.

Work cited

• Cardio-oncology: a new and developing sector of research and therapy in the field of cardiology. 2019. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/30073443/
• Cancer Treatment and Your Heart - What is a Cardio-Oncologist - CardioSmart. 2017. – American College of Cardiology. https://www.cardiosmart.org/topics/cancer-treatment-and-your-heart/what-is-a-cardio-oncologist
• Cardiotoxicity: Cancer Treatment & the Heart. 2022. ClevelandClinic.org. https://my.clevelandclinic.org/health/diseases/16858-chemotherapy--the-heart-cardiotoxicity