Tochi M. Okwuosa, DO, cardiologist and director of cardio-oncology at Rush University Medical Center in Chicago, discusses how physical health and cancer treatment interact, often resulting in negative heart health outcomes for patients under the care of oncologists .
What risk factors predispose cancer survivors to a higher risk of heart disease/damage?
Some types of typical cardiovascular risk factors, their accompanying conditions, whether they have lung disease, kidney disease – all this affects the patient. The types of cancer treatments that particularly affect the patient, the prototypical ones are the anthracyclines. These are the types of treatments that are used for breast cancer, for lymphoma, for some of the leukemias; some of the GIs [gastrointestinal] cancers use them. Anthracyclines are particularly known to cause heart failure and cardiac toxicity. But there are many others.
Trastuzumab, or Herceptin, type of treatment, anti-HER2 [human epidermal growth factor receptor 2] therapy used to treat breast cancer. Then there are the tyrosine kinase inhibitors which are used for virtually all different types of cancer, in one shape or form, that have cardiovascular consequences like heart failure and hypertension etc. There are Bruton kinase inhibitors such as ibrutinib and acalabrutinib, which increase the risk of arrhythmias. There is 5-FU, or 5-fluorouracil, and capecitabine, which increase the risk of coronary spasms and heart attacks as a result.
There is radiation therapy that increases the risk of valvular heart disease, coronary artery disease, arrhythmias, pericardial disease. And then there are newer, more modern therapies like immunotherapies that can increase the risk of myocarditis, or inflammation of the heart muscle, and there’s CAR [chimeric antigen receptor] T-cell therapy, which is also a type of immunotherapy, can cause what we call CRS, or cytokine release syndrome, which can have consequences on the heart and cause cardiovascular collapse and hypotension, which can lead to in death. And the stem cell transplant, which has long-term consequences, because it’s not just the chemotherapy that they get before the stem cells and during the stem cells, it’s also a function of the immunosuppressive therapy that some of them have to do for a long time. which can affect the heart.
Virtually all different forms of cancer have some type of therapy or therapies that have cardiovascular consequences that we need to think about. And that’s on top of comorbid conditions and cardiovascular risk factors and social determinants of health and all these other things that can affect patient outcomes.
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