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

OncoLink Team
Last Reviewed: June 21, 2018

What is the risk?

A group of chemotherapy medications called anthracyclines are known to cause heart (cardiac) toxicities, including cardiomyopathy, left ventricular dysfunction (weakening of the heart muscle), arrhythmias (rhythm abnormalities), and heart valve problems. Anthracyclines include doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone. Toxicity can develop anywhere from shortly after completing chemotherapy, to decades later, making heart health an important consideration for cancer survivors. The risk of developing heart problems is related to the total dose of the anthracycline chemotherapy a person received and the age at which you received the medication. In general, higher doses mean higher risk of developing a heart problem. Survivors who were younger in age at the time of treatment are at a slightly higher risk.

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, a cardiac assessment (heart exam) should be done prior to any planned surgery or if the survivor is pregnant or trying to get pregnant. A history of coronary artery disease, other heart disease, or hypertension (high blood pressure) also increase the risk of developing heart problems from chemotherapy.

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

Risk is further increased 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.

The Children’s Oncology Group Long-Term Follow Up Guidelines give recommendations for heart testing based on exposures.

Symptoms/ When to Call

Cardiac (heart) toxicities can cause symptoms such as:

  • Shortness of breath (with or without exertion)
  • Orthopnea (difficulty 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 Treatment

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

  • Avoiding smoking and drug use.
  • Maintaining a healthy weight.
  • Getting regular physical activity.
  • Eating a diet high in fruits and vegetables.
  • Weight, blood pressure and cholesterol should be monitored by your medical team.

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