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When You Have Cancer and Heart Disease

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Posted by Eman A. Hamad, MD

Having both cancer and heart disease can be scary. In some cases, the treatments used to fight the cancer can also hurt the heart. Fortunately, there’s a specialty for this exact situation. It’s known as Cardio-Oncology.

Shared Risk Factors of Cancer and Heart Disease

Some risk factors are common to both heart disease and certain cancers. They include:

  • Older age

  • Obesity

  • High blood pressure

  • Diabetes

  • High cholesterol

  • Tobacco use

Coronary Artery Disease

One type of heart disease called coronary artery disease (or “CAD”) may lead to a higher rate of gastrointestinal cancer. Some of these risks can’t be prevented, like aging. Others can be managed with medication and lifestyle changes, such as improved diet, exercise and stress management.

Tobacco Use

One risk factor has a simple solution: don’t use any kind of tobacco. No matter how many times you may have tried to quit, every attempt brings you closer to success. Plus, there’s a lot of help available, from support groups to medication.

Treatment: A Delicate Balance

If you have heart disease and cancer, the most serious condition must be treated first. That’s usually heart disease. However, there must be a balance between treating heart disease and the risk of interrupting cancer treatments.   

When treating heart disease, the goal is to control its symptoms. This will keep it from getting worse and leading to other problems like a heart attack.

Your doctor will weigh several treatment options. The first is medication. The second is surgery. The chosen strategy will consider how bad your heart disease is, the stage of your cancer and your general condition. 

One of the most important things a cardio-oncologist will consider is your risk of cardiotoxicity – heart damage that is caused by chemotherapy or radiation. Based on several factors, your doctor will come up with a “risk score” for you.  

If you’re at high risk, you may be put on medicine to protect your heart. If you’re at intermediate risk, your doctor will discuss with you the risks and benefits of starting medical therapy to protect your heart before you start chemotherapy.

Rules for Surgery

Surgery is a scary option for most patients. Your medical team will discuss your case before taking any action and talk to you before proceeding. They will discuss risks and benefits of surgery so that you can make the decision that is right for you.

Your cardiologist needs to know the risks of non-cardiac surgery. If your tumor needs emergency surgery, heart evaluation will be limited to what is feasible. If you have coronary artery disease, its stability needs to be established. Serious heart disease requires treatment before cancer surgery.  

When cancer surgery is a viable option, its risk should be known. For example, breast, endocrine, reconstructive, gynecologic and minor urologic operations are considered low risk. Abdominal and urologic operations are considered intermediate risk.

Finding a Cardio-Oncology Specialist

Cancer treatments have improved greatly in recent years. This makes it likely that more surviving patients will develop heart disease later in life. The demand for cardio-oncologists is only going to grow if this happens.  

At the Temple Heart and Vascular Institute, we have a Cardio-Oncology Program at Temple University Hospital and at Temple University Hospital – Jeanes Campus, located next to Fox Chase Cancer Center. This program manages patients who have heart disease and cancer, or who are at risk of developing heart disease due to cancer therapy.

If you or someone you know is one of these patients, call us at 800-TEMPLE-MED or request an appointment so we can start your care and answer any questions or concerns you may have.

Eman A. Hamad, MD

Dr. Hamad is Director of the Advanced Heart Failure and Transplant Program, Director of the Cardio-Oncology Program, and Medical Director of the Mechanical Circulatory Support Program at Temple University Hospital. She specializes in advanced heart failure therapies including heart transplantation and mechanical circulatory support. She is a member of several organizations, including the International Society of Heart and Lung Transplantation and the American Heart Association.

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