Q:  I read that certain cancer treatments can cause side effects to the heart. Is this true?

A:  While new therapies are helping more people survive cancer, it is true that some therapies can cause heart problems, such as congestive heart failure, arrhythmias, ventricular dysfunction, and even heart attack. That's because some chemotherapy drugs used to kill cancer cells also can damage cells belonging to the cardiovascular system. 

The American Heart Association recently found that breast cancer survivors over age 65 are more likely to die from cardiovascular disease than breast cancer, and the AHA warned breast cancer patients to weigh the benefits of particular treatments against heart disease.

The chemotherapy drugs that most often cause heart damage are anthracyclines, which are used to treat a variety of cancers. Others include mitoxantrone, paclitaxel and cyclophosphamide. Newer, targeted therapies such as Herceptin are thought to cause temporary damage; problems typically reverse once treatment is finished. In rare cases, immune-boosting therapies called checkpoint inhibitors can prompt a serious immune attack on the heart.

A new medical specialty called cardio-oncology is working to identify patients who are about to have chemotherapy or undergo treatment and evaluate them for a possible heart problem.

One tool to help screen patients is called three-dimensional echocardiography with global longitudinal strain. It can be used to describe the elastic properties of the heart muscle. With this test, we can identify whether a patient will need pre-treatment with medications to prevent further heart damage. Medication that may be prescribed can include beta blockers, ACE inhibitors, and angiotensin receptor blockers.

Cancer treatment can be a double-edged sword, curing one disease while creating another. But not all cancer treatments cause cardiac side effects. Patients should discuss with their physicians the benefits and risks of potential treatments to their heart health and make an informed decision regarding the best option for them.

Geoffrey Zarrella, DO, FACC, is a cardiologist with Lourdes Cardiology/South Jersey Heart Group.