Cardiotoxicity – sounds like a scary word and something that you don’t even want to think about yet alone learn about.  But remember – Knowledge is Power – so let’s dive in a little bit and learn what we need to so we can be empowered.

Treatment needed to fight cancer comes with side effects.  The side effects that occur during treatment – acute symptoms – can include extreme fatigue, hair loss, nausea, just to name a few.

Because the treatments used to fight cancer are so powerful, other areas of the body – not just the cancer cells – are affected.  The side effects from this damage may take years to show up.  Although you know all about the acute symptoms, you may know less about the long term side effects of cancer treatment.

As a Cancer Exercise Professional, it’s mandatory for me to know about the different ways that cancer and cancer treatment can affect the patients I work with.  I need to make sure I know the risk factors that can affect not only Pre-Exercise Assessments but how I develop each patient’s exercise program.  Certain risk factors will mean that modifications are required to keep patients safe – which is ALWAYS the number one goal.

So I want to give you an outline of one of the long term side effects of cancer treatment that affects the heart – cardiotoxicity.  Just like with acute symptoms  – not all patients have the same side effects – but some patients are more at risk than others.

What is Cardiotoxicity

Cardiotoxicity occurs when something within the body damages the heart.  With cancer patients, this can occur with the type of treatment you receive to fight cancer.  The damage can occur to the tissue of the heart or the blood vessels that support the heart.  The damage can be temporary or permanent and can be mild or severe.

What Causes the Damage

There are three main types of cancer treatment that can cause cardiotoxicity.

1. chemotherapy
2. radiation treatment
3. targeted therapy

1. Chemotherapy

Certain chemotherapy drugs are known to affect the heart.  The most common are a group of drugs called anthracyclines which are used to treat many different forms of cancer.  Anthracyclines include the chemotherapy agents:

• Daunorubicin
• Doxorubicin
• Doxorubicin liposome injection (Doxil)
• Epirubicin
• Idarubicin
• Valrubicin

2. Radiation

Radiation to the chest can cause issues by increasing inflammation to the heart and damaging the blood vessels of the heart.  Although the risk has decreased with better focused radiation, there are a number of cardiac risks associated with this form of treatment.

3. Targeted therapy

Targeted therapy uses specific drugs that ‘target’ a specific gene or protein within a tumour.  Targeted therapy drugs that can cause heart damage include:

• Herceptin
• Avastin
• Tykerb
• Sutent
• Nexavar

Symptoms 

Some patients may not have any long term chemotherapy side effects or symptoms from the treatment known to cause cardiotoxicity.  Other patients may have:

• shortness of breath when exercising
• shortness of breath at rest
• chest pain
• weight gain
• ankle swelling
• change in heart rate
• fatigue

Other symptoms may be life threatening including heart attack and the development of congestive heart failure.

Symptoms can start to show up during treatment.  If so, your treatment may be altered or you may be prescribed medication to help your heart.

Who’s At Risk

According to the NCCN (National Comprehensive Cancer Network) older patients, young children, women, and patients who may already have heart conditions are at increased risk.

Research has shown that some damage may be reversible – and the amount of damage may be dependant on the amount of chemo received.

How do You Stay Safe

Your doctor and you will work together.  This may include the following:

• a physical exam
• echocardiogram
• chest x-ray to look at the size of your heart
• ecg to check your heart’s electrical activity

Your doctor may decide to complete an echocardiogram before, during and after chemotherapy treatment to monitor the affects of chemo on your heart function.

Remember – Knowledge is Power.  Cardiotoxicity can be a scary thing but ignoring the facts won’t make them go away.  Take charge and see if you have any risk.  Review what treatments you are receiving or have received and check them against the list I’ve provided in this post.  Talk to your doctor and Oncologist.  If you have any risks, make sure you have a complete Pre-Exercise Assessment before engaging in exercise during or after treatment.

NCCN: National Comprehensive Cancer Network