By Charlotte Huff
Heart of the Matter
Doctors are learning more about the cardiovascular risks of cancer drugs
By Charlotte Huff
Illustrations by Nicolle Rager Fuller
For Vicky Duck, the irony was literally heartbreaking. After she lost nearly a year to surgery and treatments for a dual cancer diagnosis—breast cancer and Hodgkin lymphoma—both malignancies appeared to have been eradicated. But her heart problems were just beginning.
One day, following some tests of her heart function, Duck met with a cardiologist. Then 46 years old, Duck vividly recalls what he said: “ ‘We got the cancer, but we’re sorry about your heart. We hope we can give you decades, but it might only be five years.’ ”
Duck’s symptoms of heart failure, attributed to intensive radiation of her chest and an aggressive chemotherapy regimen, worsened until the Houston design consultant was admitted to a hospital intensive care unit five years later, in early 2002, struggling to breathe. “Any time I had a little spell, I thought I was breathing my last,” she says.
The knowledge that powerful cancer treatment can inflict collateral damage on the heart is nothing new. Oncologists have been aware for decades of heart risks related to radiation and anthracyclines—a class of chemotherapy drugs that includes doxorubicin (Adriamycin) and daunorubicin (Cerubidine). Depending upon the age, heart problems and other medical conditions of the patient involved, the lifetime risk of heart failure related to anthracyclines can run as high as 40 percent. But medical attention has also started to coalesce more recently around the smaller but very real risk of heart effects—ranging from high blood pressure to heart failure—from some of the newer and more targeted cancer drugs, such as trastuzumab (Herceptin) and sunitinib (Sutent).
A committee affiliated with the Heart Failure Society of America is in the process of finalizing guidelines related to heart toxicity and a variety of cancer drugs, says Thomas Force, a cardiologist at Philadelphia’s Thomas Jefferson University who sits on that committee. In short, the emerging field of what’s sometimes dubbed cardio-oncology has gained some traction, according to Force and other physicians.
“I think initially there was difficulty getting oncology and cardiology together on this,” he says. “I think there was the sense that [the potential for heart issues] wasn’t a problem or, if it was a problem, it paled by comparison to the cancer. And that’s absolutely true. The issues of cardiotoxicity become secondary, for sure. But we don’t want to ignore them.”