Imaging can be an important part of the treatment process for cancer patients dealing with potential heart problems, Mary Norine Walsh, president of the American College of Cardiology, said at this year’s American Society of Nuclear Cardiology Annual Meeting.
Norine Walsh, MD, called many patients whose cancer therapies have put them at an increased risk for cardiovascular disease “often lost to follow-up” and lauded new cardio-oncology programs that merge cancer and heart treatments to create a more comprehensive recovery plan for patients. She also cited two scientific papers, including a recent piece in the Journal of Clinical Oncology that outlines recommendations for prevention and monitoring of cardiac dysfunction in adult cancer patients.
Experts reviewed two decades’ worth of clinical trials, experiences and observational studies to construct guidelines for cardiologists and oncologists who might be part of a multidisciplinary cancer care team.
Here are five important takeaways:
1. Certain cancer treatments can put patients at higher risk for cardiovascular dysfunction.
The paper’s authors wrote that if a cancer patient has any cardiovascular risk symptoms, including hypertension, diabetes, dyslipidemia, smoking and obesity, they should be considered at increased risk for heart disease during or after cancer therapy. Patients over 60 years old are also at increased risk, they wrote, as are individuals with already-compromised cardiac function. The experts also recommended avoiding high-dose anthracycline, high-dose radiotherapy and combined lower doses of the two.
2. Subclinical left ventricular (LV) dysfunction is common in cancer survivors, but cardiologists often aren’t involved in treatment.
Anyone treated with anthracyclines or HER2 therapeutics should have their left ventricular ejection fraction (LVEF) assessed, Norine Walsh recommended, explaining that measuring LVEF can be tricky. She said oncology was changed by the fact that doctors can now monitor LV function in cancer patients before, during and after their cancer treatments. Knowing this can not only be preventative, but also help doctors estimate a patient’s proximate risk of death.
3. Undergoing echocardiograms several months after cancer treatment can help detect early signs of cardiotoxicity.
The authors of the paper said they believe any cancer patient should undergo extensive screening for additional health risks before starting any new, potentially cardiotoxic treatments. They recommended a thorough physical exam, assessment of family history, screening for cardiovascular disease risk factors and an echocardiogram as necessary precautions.
4. Cardiac MRIs aren’t just for patients with symptoms of heart disease.
According to the guidelines, screening for cardiac complications in patients who show any clinical signs or symptoms of cardiac dysfunction could be crucial. In the absence of access to an echocardiogram, the experts said an MRI would do—specifically a cardiac MRI. These can take place between routine visits or even after treatment, they wrote, and can be effective preventative measures even in cases where a patient is asymptomatic.
5. We can potentially prevent the development of cardiac disease in cancer patients if we take the right precautions.
Using echocardiograms, MRIs and good, old-fashioned clinical checkups to screen for heart complications can go a long way, the paper’s authors wrote. Avoiding or minimizing the use of cardiotoxic therapies and frequent examinations could save lives.