Treatment of cancer in cardiology

Who is Cardio-Oncologist

Cardio-oncology is a new field in cardiology. Cardio-oncologists are typically cardiologists who see cancer survivors or patients getting cancer treatment who develop side effects that affect the heart. Cardio-oncologists have a special interest in and knowledge about cardiac side effects of chemotherapy, targeted therapy and radiation to treat cancer. Since it is a fairly new field in cardiology, many U.S. cities do not yet have cardio-oncologists.

If you are having symptoms that you think could involve your heart, talk to your cancer doctor (oncologist) or primary care doctor. If your doctors are concerned, they can refer you to a cardiologist or a cardio-oncologist. Make sure to learn about what side effects can be caused by your cancer treatment. That way you can help to inform your health care team.

How Do I Find a Cardio-Oncologist?

You may find a cardio-oncologist at many academic medical centers and other centers across the United States. Searching the department of cardiology website of the medical school nearest you can help you find a cardio-oncologist. Also, ask your cancer doctor as he or she may know a cardio-oncologist in the area.

Exams and Tests

What types of heart tests might you receive before beginning your cancer treatment? Tests may include:

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a picture of your heart’s electrical activity. Some cancer treatment makes certain measurements on an ECG change so you may have more than one ECG during treatment. An ECG can detect abnormal heart rhythms, called arrhythmias.

Studies to Measure Ejection Fraction

In many ways, your heart is a muscle like those in your arms or legs. The muscle of your heart is in the left ventricle. Every time your heart beats, it is expected that a certain amount of blood is pushed out of your left ventricle to the rest of your body with each heartbeat: This is known as your ejection fraction. In general, an ejection fraction of greater than or equal to about 55% is considered normal.

Some cancer treatments can lower your ejection fraction. If you have had chemotherapy or radiation in the area of the heart, you may receive several echocardiograms during treatment, for years after treatment or both. Studies for ejection fraction:

  • Echocardiogram
  • Multigated acquisition (MUGA) scan (involves your receiving a radioactive solution given through a vein using an intravenous (IV) line and then having an X-ray taken)
  • Cardiac MRI

Cardiac Catheterization

During a cardiac catheterization, a thin tube or catheter is guided into an artery, usually in the wrist or leg, and up to the heart. The test goes into the body to directly evaluate the arteries of the heart.

Tips for Staying Healthy

As part of your cancer treatment, radiation may play a role. Depending on the type of cancer, stage of your cancer, location of your cancer, and other therapies (such as chemotherapy), you may have an increased risk of heart disease after completing therapy. Remember that it is very important to consider these treatment options with your doctor. It is crucial to understand the side effects and risks of your therapy, but to weigh these against the potential benefits in helping to control or cure your cancer.

After you complete your cancer treatment, it is not uncommon to feel as if you have no control over what happens to you or your body in the future. However, the good news is that there are in fact several steps you can take to decrease the risks of heart damage and stay healthy after cancer therapy.

Here are some tips to help you stay healthy:

1. Follow-up with your doctor. It is important to follow your oncologist’s recommendations for checkups after you finish your treatment. These follow-up visits are necessary to ensure the cancer has not returned as well as to watch for side effects from the treatment you received. Be sure to receive any lab tests or other tests that your doctor has ordered and follow up on your results. You may need an echocardiogram (an ultrasound of your heart; See Section 5 and link to echocardiography) after receiving certain chemotherapies or radiation, have blood tests or other cardiac imaging tests. Discuss this with your doctor and ask when and for how long you should receive these tests.

2. Stay active. Studies have shown that increased physical activity results in a decrease of heart disease after radiation therapy. Find something you enjoy doing such as jogging, walking, biking, swimming, yoga, or exercise classes. Get approval from your doctor, and follow a plan that keeps you active most days of the week for at least 30 minutes. Find a friend or family member who can help hold you accountable or make the activity more fun!

3. Eat healthful foods and keep a healthy weight. Eating a healthful diet can help decrease your risk of both heart disease and cancer. Try incorporating healthy foods slowly if making a big change to your diet right away is too difficult. Aim to have more vegetables and fruit in your daily meals and to decrease foods that are high in saturated fat or salt. Both Mediterranean and DASH diets are heart-healthy.

4. Stop smoking or never start! This is one of the most important steps you can take to decrease your risk of both cancer and heart disease. If you are a smoker, it is crucial that you quit. Speak with your doctor to ask about resources that can help you stop smoking.

5. Manage your stress. You are undergoing or have just completed treatment for your cancer, which was undoubtedly one of the most stressful situations you have experienced. Understandably, adding the ordinary stresses of everyday life to a diagnosis of cancer may be overwhelming. Be sure to talk to family, friends, and/or your doctor for tips on effectively managing your stress. In addition, many cancer centers or local hospitals have support groups, where you can meet with patients and survivors affected by your cancer type or similar cancers. Engage in activities that you enjoy and that help reduce your stress, such as listening to music, reading, and practicing yoga and meditation.

6. Sleep. If you are not already doing so, start practicing healthy sleep habits. It is important to get enough sleep for your heart health and overall wellness for many reasons, including the fact that lack of sleep can increase blood pressure. Try a few changes such as setting a bedtime for yourself and decreasing screen time (television, smartphone, tablet use) a few hours before bed. These small changes may help you sleep better and more deeply. Please talk to your health care professional if you have more questions about this.

7. Always listen to your body. After a diagnosis of cancer, many people become more aware of aches, pains, and lumps/bumps on their body. If you are worried about any symptoms, never hesitate to call your doctor. Also, if you ever experience severe chest pain or any life-threatening concern, dial 911.

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