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?
Patients who receive a targeted therapy medication to treat their cancer are at risk. These medications include trastuzumab (Herceptin) and tyrosine kinase inhibitor (imatinib, dasatinib, nilotinib, ponatinib, trametinib, dabrafenib, sorafenib, cabozantinib, lenvatinib, sunitinib, erlotinib, gefitinib). Things that can increase the risk of heart problems with these medications include:
- Having 2 or more cardiac 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 shortness of breath or cough.
- Difficulty breathing when lying down.
- New difficulty exercising or doing activity.
- Swelling of 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 the 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 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. Understand that 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.
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.
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).
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.