When you’re diagnosed with cancer, your doctor will develop a treatment plan that often includes chemotherapy, other anti-cancer drugs, and radiation. While these options can treat your cancer, they can also cause temporary or permanent heart damage.
“Cancer and heart disease are linked in multiple ways,” says Venmathi Indramohan, MD, co-director of Magee-Womens Heart Program at UPMC Passavant. “Breast cancer is the most prevalent cancer in women. Breast cancer, in its advanced stages, can affect the heart directly, but more importantly, cancer treatment like chemotherapy drugs or radiation can affect the heart immediately, or even worse years after.”
Cancer treatment can cause or worsen high blood pressure, heart failure, and arrhythmia.
Cancer Treatment and Your Heart
If you’re going through cancer treatment, it’s important to remember that:
- Not every cancer treatment causes heart damage.
- Not every cancer patient or survivor will develop heart disease.
- There are things you and your doctor can do to prevent treatment-related heart damage.
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Can Chemo Damage Your Heart?
Chemotherapy and other anti-cancer drugs are important medicines used to treat cancer.
You may receive these medications before cancer surgery to help shrink tumors. Or you may receive them after cancer surgery to prevent the spread of cancer cells to other parts of the body. When the cancer spreads, or metastasizes, it’s harder to treat and increases your risk of dying from cancer.
Not every cancer patient needs chemotherapy. Sometimes a different anti-cancer drug, such as immunotherapy or targeted therapy, may work better for your type of cancer.
Your cancer doctor, or oncologist, chooses which anti-cancer drugs to use based on the latest data from drug trials. These trials show what dose and length of time you need to take each drug to treat your cancer and keep it from returning or spreading.
Chemotherapy and other anti-cancer drugs, including immunotherapy and targeted therapy, can damage your heart.
“Radiation treatment even years ago can affect the heart,” says Dr. Indramohan.
The extent of the damage, and whether it’s temporary or permanent, depends on several risk factors.
Risk factors for cancer-related heart disease
Several things can determine your risk for developing heart disease from cancer treatment, according to the American Heart Association. This includes the risk of congestive failure in cancer patients.
- The type and dose of chemotherapy.
- The type and dose of immunotherapy.
- The type and dose of targeted therapy.
- The type and dose of radiation.
- Being on more than 1 cancer treatment that increases heart disease risk.
- Your heart health or heart disease risk factors before starting cancer treatment.
Does Radiation Shorten Your Life?
Radiation is an important tool in treating cancer. Doctors can use it alone or along with chemotherapy or other anti-cancer drugs to prevent the return or spread of your cancer.
Heart risks from radiation
Radiation applied to your chest, such as for breast or lung cancer, can increase your risk of heart damage, according to the AHA. Heart risks from radiation therapy include:
- Coronary heart disease.
- Damage to heart valves or valvular disease.
- Pericardial disease.
Radiation of the chest is highly targeted to avoid heart damage as much as possible. Your radiation oncologist — the doctor who manages your radiation treatments — will choose the least harmful, most effective dose for your type and stage of cancer.
Cardiovascular Disease and Cancer
Cancer treatment can also increase your risk of dying from cardiovascular disease (CVD).
CVD is the umbrella term for diseases affecting your heart and blood vessels. Types of CVD related to cancer treatment include:
- Heart disease. More than 76% of CVD-related deaths in cancer patients were from heart disease.
- Hypertension, also known as high blood pressure.
- Cerebrovascular disease.
- Atherosclerosis, or hardening of the heart arteries.
- Aortic aneurysm/dissection.
Risk Factors for Cancer-Related CVD Death
If you’re a cancer patient or survivor, certain factors can increase your risk of dying from CVD.
Type of cancer
Any type of cancer increases your risk of CVD death compared to those who don’t have cancer. But people with the following cancers make up the majority of deaths from CVD.
- Prostate cancer
- Bladder cancer
People with endometrial cancer also face a very high risk of dying from CVDs during their first year of treatment.
Age at diagnosis
The risk of dying from CVD is highest in those diagnosed when they’re younger than age 35.
Cancer survivors diagnosed before age 55 are 10 times more likely to die of CVD than someone without cancer.
The risk of dying from CVD is highest during the first year after diagnosis.
Compared to the general population, cancer survivors face an elevated risk of dying from CVD throughout their lives.
Preventing Heart Damage From Cancer Treatment
Before starting cancer treatment your oncologist, or cancer doctor, may run tests to understand your heart health and risk factors.
If your heart is not healthy enough for certain cancer drugs or radiation, your doctor may choose a different treatment. Or they can add other medications to protect your heart health and lower your risk of heart failure.
During cancer treatment, your doctor will monitor your heart health. They will check your blood pressure and heart rate.
With some cancer treatment, your doctor can order additional monitoring of your heart health. They can use imaging tests to see how your heart functions, including echocardiogram.
What happens if your heart health worsens
If there are significant changes to your heart health, your doctor may pause the treatment they suspect is causing the damage. This gives your heart a chance to recover.
Treatment can often start again after your heart has a chance to recover. Your doctor can also prescribe medications to improve your heart function. Doctors can often reverse acute heart damage caused by cancer treatment.
If your heart health improves after a pause or with medications, you can continue treatment.
If your heart health doesn’t improve after a pause or with medications, your doctor can stop treatment or switch to a different treatment.
Your cancer doctor can also refer you to a cardiologist or cardio-oncologist for further heart treatment. A cardio-oncologist specializes in preventing and treating CVD related to cancer treatment.
Even if your doctor can reverse your short-term heart damage, cancer survivors still face a higher lifetime risk of CVD.
What you can do to protect your heart
During and after treatment, it’s important to follow a heart-healthy lifestyle to protect your heart. Steps you can take include:
- Eating a heart-healthy diet.
- Getting your blood pressure and cholesterol under control.
- Getting regular exercise.
- Limiting alcohol.
- Quitting smoking.
Symptoms of Cancer-Related Heart Damage
You may have symptoms of heart damage during treatment. Or you can have them many years later. If you’re a cancer patient or survivor, here’s what you should watch for:
- Chronic cough, with no apparent cause.
- Dizziness or light-headedness.
- Trouble breathing, especially at night and on exertion.
- Rapid weight gain, including swelling in your ankles and legs.
- Fainting or weakness.
Editor's Note: This article was originally published on , and was last reviewed on .
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About Heart and Vascular Institute
The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine. We strive to provide the most advanced, cutting-edge care for our patients, treating both common and complex conditions. We also offer services that seek to improve the health of our communities, including heart screenings, free clinics, and heart health education. Find an expert near you.