Chemotherapy and the Risk for Heart Disease: For Better or Worse?

The cure to one disease may be the catalyst to another. This is evident in chemotherapy, which is one of many life-saving cancer therapies. Unfortunately, this type of therapy contributes to the long term risk of cardiovascular disease. Since chemotherapy is a common treatment for breast cancer, damage to the heart is a typical side effect. On October 9, 2007, the Journal of the American College of Cardiology (JACC) published an article on this subject in which Dr. Pamela Douglas, a Duke University cardiologist, stated that long-term effects of chemotherapy should be the focus of doctors. If followed, her advice could help the physician monitor patients in order to minimize the future risk of heart disease, and in consequence a more comprehensive treatment plan would be offered.

Millions of American women live with breast cancer (the most common type of cancer among females), and they are joined by approximately 200,000 new cases that arise each year. However, due to emerging therapies and prevention treatments, breast cancer death rates have decreased over the past few years. While this allows for more women to live longer, the possible risk of obtaining cardiovascular disease needs to be considered. Dr. Alan Campbell, medical director of oncology for Spectrum Health, says “it's a known fact that chemotherapy, used to fight cancer cells, can also weaken the heart muscle.” By carefully monitoring his patients for heart disease (as seen in the image to the left), Dr. Campbell is able to prescribe the proper treatment. This attentiveness is essential, because altering the treatment dosage is necessary at times to ensure that the incidents of heart failure do not increase. Campbell further notes that there is “relatively little damage to the heart but it's the women who have aggressive or reoccurring breast cancer that are most at risk.” This is for the reason that recurrent breast cancer is often fatal. During the ongoing treatment process, it is judicious to consider the possibility of developing cardiovascular disease, which is not typically life-ending and can be cured with existing medications.

Despite the availability of medications to treat heart disease, many other factors play a role as the cardiac culprit. A majority of older women have age-related risk factors for cardiovascular disease, such as high blood pressure. In some cases, physical inactivity, obesity, chest radiation, and stress during treatment further the incidence of heart failure and breast cancer (refer to the image on the lower right). Dr. Douglas, claims that during “the process of curing their breast cancer, we've exposed them to some pretty nasty things. And it's not just one nasty thing, it's a sequence of nasty things." Currently there is much debate on whether treatments of chemotherapy should be abandoned, which would require a reassessment of the treatment guidelines by the government and health officials.

As I had discussed in a previous post, current breast cancer treatments have led to a decline in death rates. By taking this into consideration, will the elimination of treatments such as chemotherapy help rather than hinder patients? What are the possible positive and negative outcomes associated with this issue? These are questions to consider, especially when current cancer therapies have contributed to the survival of many patients. The answers to these inquiries are worth pondering, for there are various remedies that cure certain diseases, but more than a few are also implicated as the reason for the development of another sickness. Even though there are new medications being created to prevent heart damage, how can clients rest assured that these treatments will be promising? Doctors cannot guarantee the success of prospective procedures and health care consumers will have to understand that heart disease may be the next condition they battle after recovering from breast cancer. This is a reality for only about 4% of breast cancer patients, but it is pertinent that physicians take precaution and monitor for any change in the heart. Patients should also be required to get a formal heart risk assessment before receiving the final breast cancer treatment. Doing so will signal the need for extra care.