February is American Heart Month and cardiologists at M. D. Anderson are taking the opportunity to emphasize the importance of maintaining a healthy heart before, during and after cancer treatment.

When cancer and heart disease - the leading cause of death in men and women worldwide - are combined, managing both conditions can be challenging for both patients and doctors.

There's a spectrum of heart disease that's associated with cancer care, including high blood pressure, weakening of the heart muscle and congestive heart failure, according to Guilherme H. Oliveira, M.D., assistant professor in the Department of Cardiology at M. D. Anderson. "The role of cardiac care in cancer treatment is becoming more important than ever," Oliveira says.

"While newer cancer treatments offer patients a better chance of survival, many also have a direct impact on the cardiac system." For example, Oliveira explains that newer targeted therapies zero in on and destroy the molecules that are essential for the survival of cancer cells. But these are the same molecules that are vital for optimal functioning of heart cells.



Who's at risk
While cardiotoxicity can occur in any patient, Oliveira points out that only about 20% of cancer patients will develop treatment-related heart complications. Because many cancer patients are over the age of 50, the chances are fairly high that they have pre-existing heart disease when diagnosed with cancer. Even those without a prior cardiac condition may develop heart problems as a result of the drugs they're taking for cancer treatment. Certain therapies are known to bring a higher risk of cardiac complications, including drugs in the anthracycline family (including doxorubicin, epirubicin, idrarubicin and daunorubicin) and tyrosine kinase inhibitors, like trastuzumab (Herceptin).

What to look for
Symptoms of heart failure - such as fatigue, shortness of breath, tightness in the chest and swelling in the lower extremities - are very similar to those of cancer and other diseases like diabetes, obesity and cirrhosis, and often go unrecognized. "Patients need to be aware that not all side effects experienced are caused by the cancer treatment itself and that feeling ill while taking a certain medication may signal insidious onset of heart failure," Oliveira says.

There's always hope
Considering potential cardiac complications that can result from cancer treatment is daunting for any patient, but should not preclude cancer treatment because side effects can often be managed or even prevented if addressed early.

"There are therapies that can prevent or reverse damage to a weakened heart and so there is always hope in the things that we can do and the ways we can help patients navigate and balance cardiac care and cancer treatment," Oliveira says.

According to Oliveira, multidisciplinary management of cancer treatment with close communication among the oncologist and cardiologist is key to protecting the heart.

Most importantly, a healthy heart is much more tolerant of aggressive cancer therapies than a diseased heart. So, a healthy lifestyle including regular exercise, proper nutrition and not smoking will help improve a patient's treatment outcomes on both the cancer and cardiac fronts.

Questions will be answered live on Feb. 25

Do you have more questions about how to take care of your heart during cancer treatment? Guilherme H. Oliveira, M.D, will be available live on Twitter Thursday, Feb. 25, to answer your questions. Follow @Cancerwise on Twitter and the hashtag #CancerandHeart, or join us on tweetchat.

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