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.
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)
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.
Change in alertness
Chest pain, pressure, tightness
Cough or wheezing with or without white or pink-tinged sputum
Dizziness, lightheaded, fainting
Fatigue or weakness
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
Swelling in arms, legs, ankles, or abdomen
Very fast or slow heart rates
Sherri Porterfield, RN, MSN
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.
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.
< 120/80 mm Hg
< 200 mg/dl
< 150 mg/dl
> 60 mg/dl
< 130 mg/dl
Weekly: Minimum of 150 minutes of moderate activity or 75 minutes of vigorous aerobic activity
Body mass index of 18.5-24.9
· 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
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
Sherri Porterfield, RN, MSN is a Nurse Navigator with Arizona Blood and Cancer Specialist with over 25 years of experience.