Cardio-Oncology: Cancer Treatment and Your Heart

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Cancer Treatments Can Harm the Heart: What You Should Know

With nearly 17 million cancer survivors in the United States thanks, in large part, to advances in cancer therapies, there are many reasons to be hopeful.

Cancer treatments save lives. But sometimes these same lifesaving treatments can damage your heart and might increase the risk of heart disease—or worsen any heart issues you might have already. 

Certain cancer treatments can weaken the heart, disrupt the normal heart rhythm, or injure blood vessels or heart valves. They also may make risk factors for heart disease, such as high blood pressure or high cholesterol, more likely.

For some people, these heart issues may develop soon after starting cancer treatment. In other cases, they can go undetected for years—perhaps even decades—after being cancer-free. Many cancer survivors are living long enough to experience the effects on their heart health. That’s why it’s so important to think about your heart health before, during and after undergoing cancer therapy.

And while there is much excitement about newer cancer therapies, we don’t fully know how they might affect the heart or other organs.

The good news?

There is more awareness of the heart harms that may be triggered by many cancer therapies than ever before.

  • Research is underway to find ways to lessen or prevent this heart damage
  • Many heart doctors (called cardiologists) are now working alongside cancer doctors (called oncologists) to help keep patients’ hearts healthy during and after cancer treatments
  • Many hospitals and cancer centers have opened cardio-oncology clinics that focus on integrating cardiovascular health as a part of cancer care

Ask your oncologist or primary care doctor whether you should see a cardiologist.

Your Heart Matters, Too

If you or a loved one has faced cancer, you know it can be very overwhelming. Frequent cancer treatments can be grueling, and cancer can take a serious emotional and financial toll. There’s a lot to consider, and managing your heart health during and after cancer treatment is very important, too.

Keep in mind that not all cancer treatments cause heart problems, and not everyone who receives cancer therapies will end up having heart troubles. Still, you should:

  • Discuss your heart health with your care team
  • Ask whether the cancer treatments you’ve had—or expect to receive—can affect your heart and in what ways
  • Keep a record of what cancer treatments you have received and when
  • Live a heart-healthy lifestyle by keeping an eye on your diet, physical activity and blood pressure and cholesterol levels
  • Ask if you need regular heart checkups after treatment, and how often

It's important to learn more about how cancer treatments can affect the heart and strategies to stay on top of your heart health before, during and after undergoing cancer therapy.  

“Not every person who has been treated with cancer therapies that can affect the heart is going to develop heart disease. But whether you have heart disease when you find out you have cancer or not, it’s good to be aware of possible effects on your heart. That will help you ask the right questions.”—Martha Gulati, MD, FACC, and CardioSmart editor-in-chief

Cancer and Heart Health: What We Know

Not everyone who undergoes cancer treatment will develop a heart problem. Still, if you or a loved one has cancer or a history or cancer, it’s important to be aware of the connection and to ask questions about your heart health, too. Here’s why. 

People with cancer need lifesaving cancer treatments, some of which can damage the heart and blood vessels. It’s important to remember that these heart diseases can be managed with the help of the right health care team. Be sure to discuss specific cancer therapies or combinations of therapies with your care team so that you understand the potential side effects and work with your doctor to make informed decisions. 

Many people already have risk factors for heart or blood vessel disease when they find out they have cancer. These can make treatment-related heart problems even more likely. Risk factors are conditions or behaviors that increase your chance of heart problems. For example, type 2 diabetes, high cholesterol, high blood pressure, smoking, or being overweight are considered risk factors for heart disease. 

Heart issues may appear years—even decades—after cancer treatment ends. Some cancer therapies set the stage for heart disease to develop later in life. This is potentially because of earlier injury or scarring to the heart muscle, lining of the blood vessels or valves. 

When undergoing cancer treatment, physical and emotional health can decline too. Coping with cancer can be overwhelming. Treatments, including surgery and cancer-fighting medicines, coupled with prolonged recovery times can mean lost muscle mass and decreased fitness. These effects can tax your body and heart. Ask what you can do to get back to some level of activity when you are ready. It may also help brighten your spirits.  

Cancer itself can also make certain heart problems more likely. There is overlap between the risk factors for cancer and the risk factors for heart disease. For example, smoking is a risk factor for both diseases.  Moreover, cancer can increase one’s risk of blood clots, which can lead to stroke and other complications 

Researchers are also discovering many cancers and heart problems may be more connected than previously thought. 

Whether your heart will be harmed depends on how healthy your heart is going into treatment, your age and which cancer therapies you receive. However, even people who are young and fit can have heart issues with some of the treatments that are used, so be sure to talk with your care team.
Your doctor may want to measure your heart function before you start cancer therapy. This is done with an echocardiogram, an imaging test that shows moving pictures of your heart and how it is working. Echocardiograms, other heart tests and bloodwork can also be used during and after treatment to check for early signs of heart failure, injury to the heart or both. 


Cancer Treatments Linked to Heart Problems

Only certain cancer therapies are linked to heart troubles. These may include:

  • Radiation therapy, especially when given to the chest because it’s so close to the heart
  • Certain chemotherapy medicines, particularly anthracycline-based chemotherapy, though the amount used today is less than that used in previous decades
  • Certain targeted therapies or newer immunotherapy drugs 

Other factors can play a role in how likely someone is to develop heart troubles as a side effect of their cancer treatments. For example, if you:

  • Already have heart disease—that is, before finding out you have cancer
  • Have risk factors for heart disease—such as high cholesterol, high blood pressure, diabetes, being overweight or smoking
  • Older age
  • Receive higher doses of chemotherapy or radiation therapy
  • Are on more than one treatment known to have damaging effects on the heart (for example, chest radiation therapy in addition to an anthracycline-based chemotherapy and trastuzumab)


Heart Problems Linked to Cancer Treatments

Some heart problems or diseases can arise during or long after cancer treatment. These can include:

  • Heart valve disease: The valves of the heart may become too narrow, stiff or no longer close property; this can disrupt usual blood flow through the heart and to the body.
  • Cardiomyopathy or heart failure: Weakening or stiffening of the heart that affects the ability to pump enough blood to meet the body’s needs.
  • Myocarditis: Inflammation of the heart that can be due to infection or certain medications.
  • Coronary artery disease: Blockages or scarring in the heart’s arteries. In particular, radiation therapy near the heart can make a buildup of plaque (called atherosclerosis) happen faster than would usually be expected. In some cases, this can lead to a heart attack.
  • Heart rhythm problems: The most common is atrial fibrillation, or AFib, which is also a leading cause of stroke. Tachycardia—when the heart beats too fast—can also occur.
  • Thickening or damage to the outside lining of the heart
  • Blood clots and stroke: Dangerous blood clots are more common in people with cancer.


What You Can Do 

Taking charge of your heart health during and after cancer treatment is an important part of your cancer survivorship journey.

  1. Know and write down any cancer treatments you receive. Record the name of the therapy, amount (dose) and how long the treatment lasted. Ask which, if any, have been linked to heart issues. Keep a health binder or folder so you won’t forget. Your personal history of cancer should be part of any discussions you have with your care team about your cardiovascular health. That means sharing which cancer treatments you’ve had and listing these along with things like high blood pressure, cholesterol, diabetes, smoking and family history.
  2. Ask about heart checks and go to follow-up visits. For some people, routine monitoring with bloodwork, echocardiograms or other tests may be needed to help pick up on changes in heart function or early signs of damage. Noticing these changes, if any, will help signal whether you need to act.
  3. Know what signs to watch for  to catch any heart problems early on. Trust your gut. You know your body best, so if you feel something just isn't right—if you have trouble breathing or feel unusually tired or sluggish—tell your doctor and remind your care team about your cancer history, too. Some people don’t develop heart problems for many years after finishing cancer treatment.
  4. Manage other conditions known to lead to heart disease. For example, high cholesterol, high blood pressure, diabetes, and tobacco use.
  5. Make lifestyle changes that support your heart health. Find ways to:
  6. Your needs and concerns may change over time. Talk about your concerns and feelings related to surviving cancer and also making sure your heart stays as healthy as possible, too.

Watch for Signs

The following may signal possible heart issues:

  • Shortness of breath
  • Fatigue
  • Chest pain
  • Irregular, slow or rapid heartbeat, or palpitations
  • Swelling in your legs, ankles, or feet which due to a buildup of fluid in the tissues
  • Lightheadedness or dizziness

Even the hearts of younger, very active people can be affected, so it’s important to ask questions and know what can be done to protect your heart. 


Talking with Your Health Care Team

It is important to talk with your health care team about how you are feeling and share concerns along the way. 

Questions to ask:

  • Will any cancer treatments I receive harm my heart?
  • What types of heart problems should we be watching for during or after cancer treatment? Are there certain signs and symptoms I need to report?
  • What steps can be taken to lower the chance that these treatments will do lasting damage to my heart?
  • Should I be seeing a cardiologist or cardio-oncologist?
  • Do we need to be more aggressive in trying to control other risk factors I have for heart disease? Are there heart medications I should be taking?
  • How will my heart function be checked over time?
  • Does the damage from certain cancer treatments improve over time? How?
  • Should I discuss my cancer history when talking about my general heart health with my doctors in the future?
  • Can you provide a complete list of treatments I received for my cancer?


Helpful Resources 

In addition to the resources on CardioSmart.org, you can find out more by visiting:

The National Cancer Institute
https://www.cancer.gov/news-events/cancer-currents-blog/2018/cancer-treatment-heart-side-effects

National Comprehensive Cancer Network
https://www.nccn.org/patients/resources/life_with_cancer/managing_symptoms/cardiac_toxicity.aspx

< Cardio-Oncology: Cancer Treatment and Your Heart


Last Reviewed: January 2020
Medical Reviewers: Bonnie Ky, MD, MSCE, FACC; Juan C. Lopez-Mattei, MD, FACC
CardioSmart Editor-in-Chief: Martha Gulati, MD, FACC

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