Survivorship: Heart Health After Targeted Therapy
Some targeted therapy medications can cause heart problems. This can happen while you are receiving treatment. However, the long-term risk of heart problems after these medications is not as clear. It is important to understand the symptoms of heart issues to report to your provider and the ways you can help keep your heart healthy.
Who is at risk?
If you got a targeted therapy medication to treat your cancer, you may be at risk. These medications include HER2 targeted therapies (such as trastuzumab), immune checkpoint inhibitors, and other tyrosine kinase inhibitors (30+ medications are in this category). Things that can further increase the risk of heart problems with these medications include:
- Having 2 or more cardiac (heart-related) risk factors makes your risk higher. These include smoking, high blood pressure, diabetes, high cholesterol, and obesity.
- Having heart problems such as heart attack, heart failure, or valve disease before or during cancer treatment can also increase the risk of heart problems.
- The risk is higher if you also receive other cancer medicines that can affect the heart (such as anthracyclines) or radiation that includes the heart in the treatment area.
What heart problems can occur?
The most common issues are a decrease in left ventricular function (called "heart failure") or cardiomyopathy (weakening of the heart muscle). Some patients develop high blood pressure while receiving these medications. This does not always resolve after treatment ends and should be managed with medications if needed.
What symptoms should I report to my provider?
You should be aware of the potential for heart problems and report any symptoms to your healthcare provider. Symptoms to report include:
- New or worsening trouble breathing or cough.
- Difficulty breathing when lying down.
- New difficulty exercising or doing activity.
- Swelling of your hands or feet (fluid retention).
- Palpitations (feel like your heart is beating very hard or fast).
- Chest pain should be reported immediately or be evaluated in the ER.
What can I do to keep my heart healthy?
- See your healthcare provider for a physical every year.
- Work with your provider to control other health problems that can affect your heart, such as high blood pressure, diabetes, high cholesterol, or cardiovascular disease.
- Maintain a healthy lifestyle:
- Do not smoke or use drugs.
- Maintain a healthy weight.
- Exercise regularly.
- Eat a well-balanced diet.
- If you develop any symptoms, you should have an echocardiogram and blood work to further evaluate your symptoms. You may have these tests done to screen for heart problems 12 months after finishing treatment.
- You should consider being seen in a survivorship clinic or by a cardio-oncology specialist.
It can be scary to learn about the late effects of cancer treatment. These complications are not common but knowing about them helps you stay healthy. You can learn more about caring for your health after cancer treatment by creating an OncoLife survivorship care plan.
References
Armenian, S. H., Lacchetti, C., Barac, A., Carver, J., Constine, L. S., Denduluri, N., ... & Fabian, C. (2016). Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology.
Brown, S.-A., Ray, J. C., & Herrmann, J. (2020). Precision Cardio-Oncology: A Systems-Based Perspective on Cardiotoxicity of Tyrosine Kinase Inhibitors and Immune Checkpoint Inhibitors. Journal of Cardiovascular Translational Research, 13(3), 402–416. https://doi.org/10.1007/s12265-020-09992-5
Hurtado-de-Mendoza, D., Loaiza-Bonilla, A., Bonilla-Reyes, P. A., Tinoco, G., & Alcorta, R. (2017). Cardio-oncology: cancer therapy-related cardiovascular complications in a molecular targeted era: new concepts and perspectives. Cureus, 9(5).
Omland, T., Heck, S. L., & Gulati, G. (2022). The role of cardioprotection in cancer therapy cardiotoxicity: JACC: CardioOncology state-of-the-art review. Cardio Oncology, 4(1), 19-37.
Pudil, R., Mueller, C., Čelutkienė, J., Henriksen, P. A., Lenihan, D., Dent, S., ... & Lyon, A. R. (2020). Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies: a position statement from the Cardio‐Oncology Study Group of the Heart Failure Association and the Cardio‐Oncology Council of the European Society of Cardiology. European journal of heart failure, 22(11), 1966-1983.
Steingart, R. M., Yadav, N., Manrique, C., Carver, J. R., & Liu, J. (2013, December). Cancer survivorship: cardiotoxic therapy in the adult cancer patient; cardiac outcomes with recommendations for patient management. In Seminars in Oncology (Vol. 40, No. 6, pp. 690-708). WB Saunders.
Tromp, J., Steggink, L. C., Veldhuisen, D. V., Gietema, J. A., & Meer, P. van der. (2017a). Cardio‐Oncology: Progress in Diagnosis and Treatment of Cardiac Dysfunction. Clinical Pharmacology & Therapeutics, 101(4), 481–490.