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Cancer Treatment Toxic to the Heart

The second threat cancer survivors could face.

You probably know when it comes to treating cancer, there are going to be risks. What you may not know is the same chemotherapy treatments that prolong life can also have devastating consequences on our hearts.
Fit and strong are two words to describe Derek Fitzgerald, but his life is just getting back on track after doctors found a grapefruit-sized tumor in his stomach ten years ago and diagnosed him with non-Hodgkin’s lymphoma.
“They said Derek, you’ve got cancer,” Fitzgerald told Ivanhoe.
His best shot at survival was chemotherapy. Derek underwent six rounds. It destroyed the cancer, but also damaged his heart. 
He lived with severe heart failure for seven years. Then he was placed on the transplant list.
“Every night as I closed my eyes to go to sleep, I wondered, how long can I go through this? How much more can my body take before I just close my eyes and don’t wake up?” Fitzgerald said.
It’s a reality Dr. Mariell Jessup says few patients are aware of.
“In Derek’s case, there are chemotherapy agents that actually weaken the heart,” Dr. Mariell Jessup, Professor of Medicine, University of Pennsylvania, Penn Medicine Heart & Vascular Center, told Ivanhoe.
In fact, she says treatment may put a survivor at three to seven times greater risk of developing heart disease.
“So many patients that come here say, ‘I just can’t believe something else happened to me,’” Dr. Jessup said.
Dr. Jessup recommends talking to your doctor about your risk and getting regular health screenings.
Derek found a new heart and despite having never exercised before, began to, to honor his donor. Eight months post-transplant, he ran his first 5K. Two months later he ran a half-marathon. Just two years later—he completed his first Ironman.
“Every time I get out there, it’s a celebration of this chance that I’ve been given,” Fitzgerald explained.
Derek is the first cancer and heart transplant survivor to finish an Ironman and his third chance at life keeps getting better. After struggling with infertility, he and his wife had their first baby this year.


BACKGROUND: Cancer cells grow and divide more rapidly than normal cells, so many anticancer drugs are made to kill growing cells.  However, certain normal healthy cells multiply quickly, and chemotherapy can affect these cells also.  Damage to normal cells can cause side effects.  The fast-growing, normal cells most likely to be affected are blood cells forming in the bone marrow and cells in the digestive tract (stomach, mouth, intestines), reproductive system (sexual organs), and hair follicles.  Some anticancer drugs may affect cells of vital organs, like kidney, bladder, lungs, nervous system, and the heart.  (Source: www.medicinenet.com)
CANCER TREATMENT AND HEART DISEASE:  Chemotherapy side effects may increase the risk of heart disease, including weakening of the heart muscle and rhythm disturbances (arrhythmias).  Some chemotherapy agents with cardiovascular effects include:
•arsenic trioxide (Trisenox)—Q-T prolongation  
•bevacizumab (Avastin)—Severe hypertension, heart failure, cardiomyopathy, thromboembolism
•cisplatin (Platinol)—Severe hypertension, ischemia, atrial fibrillation, thromboembolism
•doxorubicin (Adriamycin) and other anthracyclines—Cardiomyopathy, heart failure, cardiac shock
•fluorouracil 5-FU (Adrucil)—Ischemia
•Imatinib—Edema
•Interleukin-2—Atrial fibrillation
•mitomycin (Mutamycin)—Heart failure
•mitoxantrone—Heart failure
•pazopanib (Votrient)—Severe hypertension
•sorafenib—Severe hypertension, heart failure, thromboembolism
•trastuzumab (Herceptin)—Heart failure

 (Source: www.mayoclinic.org and http://www.health.harvard.edu/newsletters/Harvard_Heart_Letter/2012/August/cancer-treatments-may-harm-the-heart

PREVENTION:  If your doctor suggests using a chemotherapy drug that may affect your heart, you may choose to undergo heart function testing before starting treatment.  During treatment, you may need periodic heart monitoring.  If you have a pre-existing heart condition, like cardiomyopathy, your doctor may suggest a different type of chemotherapy.  Some cancers require radiation.  If the area of your body receiving radiation includes your heart, you have an increased risk of cardiomyopathy, heart attack, and coronary artery disease.  The combination of chemotherapy and radiation can further increase your risk of heart damage.    (Source: www.mayoclinic.org)
? For More Information, Contact:

Jessica Mikulski
Senior Medical Communications Officer
Penn Medicine Cardio-Oncology Program
215-662-4000


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