Risk for Cardiac (Heart) Problems Related to Anthracycline Chemotherapy for Childhood Cancer

Author: OncoLink Team
Content Contributor: Dava Szalda, MD
Last Reviewed:

What is the risk?

A group of chemotherapy medications called anthracyclines are known to cause heart (cardiac) toxicities. Anthracycline chemotherapies include doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone. Heart problems related to these medications include:

  • Cardiomyopathy or left ventricular dysfunction (weakening of the heart muscle)
  • Arrhythmias (fast, slow or irregular heart rhythm)

Am I at risk?

Heart problems can develop anywhere from shortly after completing treatment to decades later, making heart health very important for cancer survivors. Your risk of developing heart problems is related to the total dose of the anthracycline chemotherapy you received (over the whole course of your treatment) and the age at which you received the medication. In general, higher doses mean a higher risk of developing a heart problem. Survivors who were younger in age at the time of treatment are at a slightly higher risk.

Risk is higher for those survivors who also received radiation to the chest. Radiation, even without chemotherapy, can cause early coronary artery disease, which increases the risk for heart attack, and other heart problems.

What else can increase my risk of heart problems?

Things like anesthesia, or pregnancy in women, can cause extra stress on the heart, and increase the risk of a heart problem. For this reason, you should be seen and evaluated by a cardiologist before any planned surgery or if you are pregnant or trying to get pregnant.

Having other health problems that can affect the heart also increases the risk of heart problems from chemotherapy. These can include heart disease (coronary artery disease), high blood pressure (hypertension), high cholesterol, diabetes, and obesity. If you have heart valve problems of chronic GVHD you may need to take antibiotics before having dental work or other medical procedures to prevent infection. Talk with your care team to determine if you need this.

Certain drugs and medications can put added stress on the heart and increase the risk of heart problems and even death in survivors. These include diet pills, ephedra, cocaine, and performance-enhancing drugs.

Symptoms/ When to Call

Cardiac (heart) toxicities can cause symptoms such as:

  • Shortness of breath (with or without exertion).
  • Orthopnea (having a hard time breathing when lying down).
  • Chest pain.
  • Feeling like your heart is racing, throbbing, or beating irregularly.
  • Unable to exercise due to severe fatigue.
  • Dizziness/lightheadedness.
  • Edema (swelling of the extremities).
  • Cough or wheezing that won't go away.

These symptoms should be reported to your healthcare provider right away. Annual history and physical by a healthcare provider should include a cardiac exam and review of possible symptoms.

Prevention and Monitoring

There are ways you can help keep your heart healthy, including maintaining a healthy lifestyle. This includes:

  • Avoiding smoking and drug use.
  • Maintaining a healthy weight.
  • Getting regular physical activity. Talk to your healthcare provider if you want to start an exercise regimen or play strenuous sports.
  • Eating a diet high in fruits and vegetables.
  • Having your weight, blood pressure, and cholesterol monitored by your medical team.

What tests do I need for monitoring my heart health?

There are some tests that the Children’s Oncology Group recommends once you enter “long-term follow-up.” This is generally 2 years after finishing treatment.

  • You should have an electrocardiogram (EKG) and an echocardiogram at this time as a baseline measurement.
  • An echocardiogram may be repeated every 2-5 years, depending on the dose of anthracycline medicine or radiation you received.
  • If you received a higher dose of radiation or a combination of radiation to the heart and anthracycline chemotherapy, you may be referred to a cardiologist for stress testing 5-10 years after treatment.
  • All survivors should have a physical exam by a healthcare provider at least once a year. This exam should evaluate your heart health, blood pressure, and risk for other health concerns such as high cholesterol and diabetes.

How can I learn more about my risk?

  • Going to a cancer survivorship clinic can be helpful to learn about your own risk and ways to reduce your risk. Find a clinic on our list or call local cancer centers to see if they have a clinic for childhood cancer survivors.
  • Visit the Children’s Oncology Group website to learn more about risks and recommendations.
  • Talk with your care team about your plan for follow up care.
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