Fighting cancer is difficult, but in addition to combating the disease, many patients and their physicians also must confront the possibility of developing treatmentrelated heart disease as a consequence of chemotherapy and/or radiation. And as the number of survivors over the next several years approaches 20-million people, cancertreatment-related cardiovascular disease “is going to be much more of a common issue than people realize,” says UCLA cardiologist Eric Yang, MD. "We now know that many cancer therapies, while essential and lifesaving, may potentially have short- and long-term consequences for the patient’s heart health.
“By monitoring a patient’s cardiovascular health and symptoms proactively, we can work with our oncology colleagues to provide the best multifaceted care, with cardiovascular interventions that will allow patients to complete their cancer treatments with minimal risk to their hearts,” he says. Dr. Yang and colleagues from cardiology and hematology/oncology have established UCLA’s new Cardio-Oncology Clinic. The clinic currently has physicians at Ronald Reagan UCLA Medical Center and in Santa Monica and Ventura.
Megha Agarwal, MD, a cardiologist at the UCLA cardio-oncology clinic in Ventura, notes that patients who have been treated for cancer can be vigilant about continuing to monitor their ongoing cancer risks, "but once a cancer patient crosses the threshold of 10 or 12 years of survival, cancer may not be their main focus. They should be concerned about heart disease, which frequently is forgotten." The toxicity of chemotherapy drugs can potentially damage the heart and restrict blood flow, while radiation has the potential to form scar tissue over heart valves, making them rigid and unable to function properly. Oncologists are increasingly mindful of the potential risks that long-term cancer therapy may pose for patients. In the past, "oncologists didn’t worry as much about the potential impact of treatment years down the line on other organs; the more immediate goal was to eradicate the cancer," says Parvin Peddi, MD, a UCLA oncologist in Santa Monica and Torrance. "Now, thanks to more treatment options and increasing survival rates, we are paying attention to issues survivors may have due to their cancer therapies many years later."
Dr. Peddi says that oncologists, working collaboratively with their colleagues in cardiology, can examine a patient’s needs and risk factors to better tailor a treatment regimen that will be effective without causing additional cardiotoxicity. As an example, Dr. Peddi cites a patient who was treated about 20 years ago for Hodgkin’s lymphoma with the chemotherapy drug doxorubicin, which is known for its potential negative impact on the heart. Her patient now has another form of lymphoma and needs chemotherapy again, which can dramatically increase the risk to the heart. The questions confronting Dr. Peddi were, "Do I treat the patient’s cancer incompletely? Do I not give the patient the drug that I think is really needed because it may further damage the heart?" After conferring with her patient’s cardiologist and carefully evaluating the patient’s current heart function, Dr. Peddi prescribed a related drug that was deemed safer but would still deliver an optimum dosage under close supervision.
“Whenever there is a new cancer drug, there is a new possibility for unforeseen cardiovascular side effects,“ Dr. Yang notes. “Our mission is to understand these effects so we can better detect and treat them so that patients can continue to receive their lifesaving therapy.“