Features January 2012 Issue

New Guidelines to Help Manage Heart Disease in Cancer Patients

The use of echocardiography will help doctors measure the toxic effects of certain cancer drgus on the heart.

Cancer patients who are also at high risk for heart disease or are already dealing with cardiovascular problems require special care, because chemotherapy can be damaging to the heart.

To help physicians care for this vulnerable group of cancer patients, the American Society of Echocardiography is writing guidelines aimed at protecting them against heart failure and other cardiac complications.

Cleveland Clinic cardiologist and echocardiography specialist Juan Carlos Plana, MD, says that chemotherapy is toxic to the heart. For example, the drugs doxorubicin and trastuzumab in breast-cancer patients with the HER2 genetic mutation, can be especially harmful to the heart. He adds that heart disease is actually a bigger threat to breast cancer survivors than recurrent cancer.

“Patients at high risk (elderly patients or patients with risk factors such as hypertension, diabetes, hyperlipidemia, history of smoking, documented coronary artery disease or history of cardiomyopathy or heart failure) need to be evaluated prior to the initiation of cancer therapy,” says Dr. Plana, who is among those writing the new guidelines.

In addition to breast cancer, other forms of cancer, such as leukemia, lymphoma, sarcoma, and renal cell cancer are especially dangerous for heart patients.

The new guidelines will help explain how careful follow-up using state-of-the-art imaging (strain echocardiography) should be used at baseline and while on the therapy.

Echocardiography, or “echo,” is a painless screening test that uses sound waves to create a picture of the size and shape of the heart, as well as the functioning of the heart’s valves and chambers. Echo can also be used to identify early signs of cardiac toxicity.

The new guidelines, expected to published later this year, will be written in collaboration with the European Association of Echocardiography and the American Society of Clinical Oncology.

Dr. Plana also notes the cancer treatment can have other effects on heart health. “Cancer treatments make people tired and fatigued,” he says. “They don’t feel like exercising. The diet is sometimes less than optimal. Patients get very focused on the treatment of cancer, leaving the rest of the concerns aside.”

He adds that there are two important risk factors that cancer and heart patients can and should control: hypertension and smoking.