❤ February is American Heart Month ❤

Did you know that heart disease is the #1 leading cause of death for Americans and that 1 in 4 Americans will die of heart disease each year?

Did you also know that women who’ve had certain types of cancer treatments are at a greater risk for heart disease as well? As treatments for breast cancer have advanced, more breast cancer survivors are living with these long-term consequences of treatments. Some treatments known to have adverse effects on the heart include:

• Chemotherapeutic agents:
  • Anthracyclines (doxorubicin, epirubicin…a.k.a. “red devil”)
  • Anti-HER2 Agents (herceptin, perjeta)
• Hormonal therapies (tamoxifen, anastrozole, letrozole)
• Radiation to the breast/chest wall

For all of the treatments listed above, risk of cardiovascular disease including coronary artery disease and cardiomyopathies (dysfunction of the heart muscle) is elevated. Evidence of cardiotoxicity can show up several months to several years after these treatments are administered. So what does the research say about prevention or reversal of these cardiac side effects?

Prevention of Cardiotoxicity during Cancer Treatments

Firstly, anyone starting any of the above-listed treatments should undergo a baseline cardiac function screening such as an EKG and electrocardiogram to allow for close monitoring of the heart once treatment is administered or completed. Doctors will specifically watch the left ventricle ejection fraction which is an indicator of how well the heart can pump blood to the body.

The benefits of eating a healthy diet full of fruits, vegetables, and whole grains and maintaining a consistent exercise routine during treatment also apply to cancer patients (we’ll discuss this more in a minute). Avoidance of smoking and drinking alcohol is also very important.

From a medical standpoint, oncologists can specify the dosage, timing, and frequency of chemotherapy treatments to minimize their effects on the heart. In some instances, they can prescribe a cardioprotective medication such as a beta-blocker or ACE inhibitor to reduce strain on the heart during chemotherapy, especially if a patient is symptomatic.

Some symptoms that may indicate heart concerns include:

• shortness of breath
• swelling in the feet or lower legs
• rapid or irregular heart beat
• pain or swelling in the abdomen
• mental confusion

During radiation, the heart is most at risk if the left side is being treated. Radiation oncologists can have a person use a deep breath hold to minimize the risk of radiation to the heart. They use the radiation simulation to plan the most effective delivery of radiation and ever-advancing treatment techniques to reduce the dose of radiation to the heart.

As you can see, there are many ways to be proactive about heart health during cancer treatment. Patient should never feel as though it’s inevitable to come out on the other side of treatment with heart problems!

Management of Treatment-Related Cardiotoxicity

Should a person develop cardiac issues during cancer treatments, there are more and more evidence-based guidelines emerging for how to improve cardiac function and prevent long-term health consequences. In many cases, treatment-related heart conditions are reversible!

Just like any other muscle in the body, the heart needs to be challenged to get stronger. During cancer treatments, people tend to lose about 27% of their exercise capacity. This means that, as a survivor, it’s time to get in shape.

Ideally, patients and survivors are recommended to get 150 minutes of moderate aerobic exercise per week – that’s about 30 minutes, five days per week. Walking is a great place to start, but patients should choose their favorite type of exercise! Aerobic exercise like running, biking, swimming, or high-intensity interval training (HIIT) are very effective ways to promote healthy heart function. Those who consistently get 150 minutes per week are also shown to reduce their risk of mortality by up to 60% – perks!

From a physical therapy perspective, supervised exercise is best for a few reasons. A knowledgeable physical therapist or exercise physiologist can help prescribe exercise according to guidelines related to the phase of treatment someone is in. Someone in active treatment should not be exercising at the same intensity as a survivor who is 6-12 months out of treatment. Just like recovery from an injury, exercise progression should be progressive and individualized!

Cardiotoxicity is a serious side effect of cancer treatments and should not be overlooked. There are many options for prevention and management of heart conditions that arise for cancer patients and survivors. To find a physical therapist or exercise physiologist who is experienced working with oncology patients, ask your physician for a referral to a trusted provider in your area or use the APTA Find a PT locator!

Sending love to you!

Aloha ❤

To read more, check out these articles:
1. Cardiotoxicity of Contemporary Breast Cancer Treatments (Chuy, et al.)
2. Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity (Avila, et al.)