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Lourdes Physicians Protecting the Heart While Treating Cancer

CAMDEN, NJ—Cancer is the second-leading cause of death in the United States, right behind heart disease. While new therapies are helping more people survive cancer, they also can cause heart problems.

Last month, the American Heart Association warned breast cancer patients to weigh the benefits of particular treatments against the potential to damage their heart.

A new medical specialty called cardio-oncology is working to solve this dilemma. At Lourdes, cardiologists work closely with oncologists to help prevent heart disease in people before, during and after cancer therapy.

“Certain cancer treatments can have dangerous cardiac side effects,” said Lourdes cardiologist Jerome Horwitz, DO. “We work with our oncology colleagues as a multidisciplinary team to identify the patient who is about to have chemotherapy or is undergoing treatment and evaluate them for a possible heart problem, such as congestive heart failure or left ventricular dysfunction.”

Some chemotherapy drugs can cause cardiac toxicity, said Lourdes cardiologist Geoffrey Zarrella, DO, FACC. “The chemicals used to kill cancer cells also can damage cells belonging to the cardiovascular system.”

The chemotherapy drugs that most often cause heart damage are anthracyclines, and are used to treat a variety of cancers. Others include mitoxantrone, paclitaxel and cyclophosphamide. Newer, targeted therapies like Herceptin are thought to cause only temporary damage.

These drugs can cause conditions that lead to heart rhythm problems (arrhythmias) and heart failure, including enlarging of the heart and swelling of the heart or the sac around the heart, said Dr. Zarrella. The blood vessels also can be damaged, reducing blood flow to the heart and raising the risk for a heart attack.

Chemotherapy drugs also can interfere with blood thinners people may take to prevent clots and lower their risk of heart attack and stroke.

One tool to help screen patients is called three-dimensional echocardiography with global longitudinal strain.

“Strain can be used to describe the elastic properties of the heart muscle. It is an important checkpoint for who is at-risk going into therapy and who is experiencing subclinical myocardial damage during their chemotherapy,” said Dr. Zarrella. “By utilizing this technology, we can identify whether a patient will need pre-treatment with medications to prevent further heart damage.”

Medication that may be prescribed to prevent further damage and protect the heart include:

  • Beta blockers
  • ACE inhibitors
  • Angiotensin receptor blockers

Lourdes cardiologist Jay Rubenstone, DO, FACC, said they want patients to know that after they defeat cancer, another threat to their health can exist. For example, the American Heart Association found that breast cancer survivors over 65 are more likely to die from cardiovascular disease than breast cancer.

“Thanks to advances in therapies, more people are surviving cancer,” said Dr. Rubenstone. “We want patients to discuss with their physicians the benefits and risks of potential treatments to their heart health and make an informed decision on the best option for them.”

“Cancer treatment can be a double-edged sword, curing one disease while creating another,” added Dr. Horwitz. “By partnering with oncologists and taking proactive steps, we aim to maximize patient safety and augment disease-free survivorship.”

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