Risk of Incident Heart Failure Among Cancer Patients
Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology, Social Work
JULY 21, 2022
After reading an article in The American College of Cardiology journal, CardioOncology, I had to look up the meaning of incident heart failure. Incident heart failure is the term used to describe a first occurrence of cardiovascular disease (CVD); this includes a fatal or nonfatal stroke, a nonfatal myocardial infarction (heart attack), fatal coronary heart disease, or heart failure. These all sound pretty scary and certainly something we would hope to avoid.
This points out...the need for a collaborative and careful approach to ongoing care for cancer patients and survivors.
We know that cancer patients are at higher risk than others of dying from heart disease and stroke. A study published in 2019 suggested that the incidence could be that more than one in ten cancer patients die, not from cancer, but from heart and blood vessel problems. As I type that sentence, I wonder if part of the reason is that so many people are living longer after a cancer diagnosis and treatment. We all know that we are at higher risk of CVD problems as we age, and living longer may predispose us to this problem.
We also know that some chemotherapy drugs may damage our hearts, but patients who receive them are closely monitored before and during treatment. These drugs include anthracyclines (Adriamycin, daunorubicin, and epirubicin), cisplatin, carboplatin, Taxol, and cyclophosphamide. At the time of beginning treatment with any of these medications, we are informed about the possible risks, as well as knowing that the urgent need is to treat the cancer.
The National Cancer Institute has reported that certain cancer treatments, including the drugs above and radiation therapy, can damage the heart and cardiovascular system. People who already have high blood pressure, irregular heart rhythms, or heart failure are at risk for worsening their problems. Since cancer is often a disease more common among older people, it is likely that some patients begin cancer treatment with pre-existing cardiac problems.
Again, this all seems an impossible quandary. We all know how terrifying it is to receive any kind of cancer diagnosis, and almost all of us concentrate on trying to treat the cancer and keep it away. This is appropriate.
Let us return to a recent study that stimulated this blog. Although it has been known that people with cancer or with a history of cancer have a higher risk for incident heart failure, the information about their long-term risk for CVD problems has been unclear. However, a new study tried to answer this question.
In a retrospective study, almost five million Canadians who were treated for cancer between 2007 and 2019 were compared to other adults who had not experienced cancer, and their risks of subsequent CVD events considered. People who were diagnosed and treated for genitourinary, gastrointestinal, thoracic, nervous system, and hematologic malignancies were at the highest risk.
The conclusion was that a new cancer diagnosis, regardless of the site or type of cancer, was associated with a significantly increased risk for cardiovascular death as well as nonfatal incidents. This is not what we want to hear. What, I think, this points out is the need for a collaborative and careful approach to ongoing care for cancer patients and survivors. All of us should speak with our doctors about our personal risks and consider how best to receive the monitoring and care that will help keep us well.