Heart Health in Breast Cancer Survivors

Effects from cancer treatment need to be anticipated, prevented and mitigated. Advances in breast cancer care has improved survival. Breast cancer survivors must be well versed about heart disease too. Cardiovascular (CVD) disease refers to conditions that can narrow or block blood vessels that may result in heart attacks, high blood pressure, and strokes. Other heart conditions may affect the structure/function of the heart i.e. valvular disease, irregular rhythms, and enlarged hearts.

 

Breast Cancer

Heart Disease

Affects 3.1 million women

< 1% diagnosed in men

Affects half of US adults

42,000 women and 500 men die annually

610,000 Americans die annually

Source: American Cancer Society (2019)

Source: Centers for Disease Control (2017)

 

Risk Factors

Overlapping risk factors for both breast and cardiovascular disease include older age, tobacco exposure, being sedentary, excessive weight, high fat diet, early menstruation, and postmenopausal use of hormone replacement.

 

Cancer treatments that affect cardiovascular health

Healthcare’s goal is to preserve function and quality of life. Oncologists assess the patient’s history and weigh the benefits and risks of treatment. With treatment, potential side effects can occur quickly though generally improve once doses are reduced or completed. Late effects can also occur months or years later. 

When choosing treatment, the oncologist must assess for cardiovascular disease to accurately understand the patient’s status. Reviewing vital signs, evaluating lab work, obtaining an electrocardiogram (EKG) or an echocardiogram (ECHO), or consulting with cardiology may be necessary.

Certain chemotherapy, targeted therapy, endocrine therapies and radiation have adverse cardiovascular effect profiles. Known effects may include heart failure, cardiomyopathy, blood clots, high blood pressure, abnormal lipids, heart infections, and arrythmias. During treatment, these diseases are monitored and managed. Some patients may begin heart medications, and others may have more frequent EKGs or ECHOs.

After treatment, some breast cancer patients will be monitored for late effects or continue cardiovascular treatment. Patients and their providers need to remain alert to potential late effects based on the individual’s treatment. Survivorship care plans generally provide this information.

 

Signs and symptoms of heart disease

The presentation of heart disease varies from one individual to another. Sometimes, there are no signs and symptoms and at other times, there are obvious ones. Recognizing that these signs and symptoms may indicate heart disease is necessary for prompt diagnosis and treatment.

  • Anxiety

  • Change in alertness

  • Chest pain, pressure, tightness

  • Cough or wheezing with or without white or pink-tinged sputum

  • Difficulty breathing

  • Dizziness, lightheaded, fainting

  • Fatigue or weakness

  • Headache

  • Hypertension

  • Irregular heartbeats/palpitations

  • Loss of appetite or nausea/vomiting

  • Loss of function i.e. not able to move arm/leg or to speak/think

  • Neck, jaw, shoulder, back, or abdominal pain

  • Pain or numbness in one of both arms

  • Pounding in chest, neck, ears

  • Sweating

  • Swelling in arms, legs, ankles, or abdomen

  • Very fast or slow heart rates

  • Vision problems

Authors


Sherri Porterfield, RN, MSN

Sherri Porterfield, RN, MSN

Nurse Navigator

Sherri Porterfield, RN, MSN is a Nurse Navigator with Arizona Blood and Cancer Specialists. She has over 25 years of experience educating patients and the community. She volunteers her time, giving presentations to several different groups in the Green Valley and Tucson. Sherri is also developing Arizona Blood and Cancer Specialists' Survivorship program, and has written several articles for local publications.

Women are less likely to recognize they are having a heart attack and often downplay their symptoms dismissing them as the flu, indigestion or stress. Women die more often than men from their first heart attack.

 

Minimizing risks

Sometimes patients get tunnel vision, focusing only on their cancer, resulting in less attention to other health conditions or behaviors. Below are some targeted goals for all adults to strive towards. Avoiding tobacco, managing stress, and having regular physicals are also necessary to maximize one’s health.

 

Health Index

Normal Value

Blood Pressure

< 120/80 mm Hg

Total Cholesterol

< 200 mg/dl

Triglycerides

< 150 mg/dl

Optimal HDL

> 60 mg/dl

Optimal LDL

< 130 mg/dl

Exercise

Weekly: Minimum of 150 minutes of moderate activity or 75 minutes of vigorous aerobic activity

Weight

Body mass index of 18.5-24.9

Diet

·         25-36 grams of fiber/day

·         < 2300 mg of sodium/day

·         4-6 servings of fruit and vegetables/day

·         Increase the amount of whole grains and beans consumed

·         Limit added sugars, saturated fats

·         Consume < 18 ounces of red meat/week, increase consumption of fish

·         Limit alcohol daily to 1 drink for women and 2 drinks for men

Fasting blood sugar

< 100 mg/dl

 

Summary

Research is quickly discovering new ways to find diseases earlier, treat diseases better and provide guidance on how to live longer. Working together with healthcare providers, breast cancer survivors can minimize cardiovascular risks and disease.

 

Sherri Porterfield, RN, MSN

Nurse Navigator

Sherri Porterfield, RN, MSN is a Nurse Navigator with Arizona Blood and Cancer Specialist with over 25 years of experience.