Spirit of Women magazine is a national publication presented to women by hospitals and their physicians. The magazine provides up-to-date, evidence-based healthcare information and promotes our hospitals as leaders in women's health excellence.
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2 4 S P I R I T O F W O M E N W I N T E R 2 016 w w w. s p i r i t o f w o m e n . c o m C A N C E R C A R E (weakening of the heart muscle), which can lead to congestive heart failure, and coronary artery disease, which can cause heart attack. Although chemotherapy- related heart damage tends to show up during treatment or within the first few years after therapy, radiation- induced harm to the heart may not become apparent for 15 years or more. The good news is that radiation techniques are improving to spare the heart, and heart-healthy drugs have been developed. "We've tried to get rid of all the drugs that cause cardiac toxicities because we want patients to have a good quality of life after they beat cancer," says Dr. Benjamin Negin, a medical oncologist with Inspira Medical Center Vineland in Vineland, N.J. RISK VS. BENEFIT Still, some chemotherapy drugs with the potential to harm the heart remain in use because they're superior cancer fighters. They include anthracyclines (doxorubicin, daunorubicin), a class of drug commonly used to treat breast cancer and lymphoma (cancer of the immune cells), and HER2-targeted agents such as Herceptin (trastuzumab), pertuzumab and lapatinib. HER2 drugs are used to treat a type of breast cancer that overexpresses a protein called HER2/neu. Fortunately, cardiac side effects from these drugs are rare. In general, just 2 to 3 percent of patients who take anthracyclines develop heart problems, says Dr. Desai. Herceptin-induced heart issues are only slightly more common. Still, to protect your heart, ask your oncologist whether you should see a cardiologist before taking either type of medication. KEEPING TABS If your oncologist recommends anthracyclines or Herceptin, expect to undergo an ultrasound and an echocardiogram or a multigated acquisition (MUGA) scan of your heart at the beginning of treatment and then every three to six months during treatment. "Ultrasound looks at the ejection fraction—the amount of blood the heart squeezes out every time it beats," says Dr. Mindy Gentry, co-director of the cardiology oncology program at WellStar Health System in Marietta, Ga. Normally, it's 55 percent or higher. If it drops below that level, "we at least watch patients more closely," she says. You can also expect to undergo ultrasounds for another 12 to 18 months after therapy. An echocardiogram, on the other hand, uses sound (continued from page 23) waves to produce images of your heart, while a MUGA scan creates video images of the lower heart's lower chambers to check whether they're pumping blood properly. IV medication (dexrazoxane) is available for anthracycline patients, given concurrently with chemotherapy, to help counteract the negative heart side effects of chemo. If scans indicate that your heart function is declining over time, your doctor may want to switch you to a different, heart-sparring chemotherapy drug. The downside? The new drug might be less effective at preventing your cancer from returning. But once Herceptin is stopped, heart function will improve in many women, although anthracycline-induced heart problems are not reversible, and they may require medication to help your heart work efficiently. Overall, treating cancer with an anthracycline or Herceptin is a balancing act and a calculated risk, say the experts. "We try to keep people on a chemo regimen that's going to give them the best chance of survival for as long as we can," Dr. Gentry says. • If your doctor recommends an anthracycline drug or Herceptin to treat your cancer, or you receive radiation treatments in the chest area, be sure to: • Get yearly checkups. "It's common for your oncologist to become your main physician and forget about everything else," says Dr. Mary Cianfrocca, a medical oncologist with Banner MD Anderson Cancer Center in Gilbert, Ariz. But your primary care physician is an important part of your health care team too. During and after cancer treatment, "see your [primary care provider] regularly to monitor your blood pressure, cholesterol, weight and your risk for diabetes," she says. • Report unusual symptoms. Tell your doctor if you feel short of breath, especially when lying down. Other symptoms to report immediately include chest pain and unusual swelling in your legs. • Lead a heart-healthy lifestyle. Exercising regularly, eating a balanced diet that's rich in fruit and vegetables, and maintaining a healthy weight is good for your heart. It can help you stay strong physically and mentally both during and after cancer treatment. Take charge of your heart health