Cardio-Oncology: Heart Health & Side Effects During Cancer Treatment

•Increasing prevalence of heart diseases in cancer survivors : Improved cancer treatments mean that more cancer survivors are living with side effects from their treatments, including heart-related issues.

•Unexpected cardiac side effects : Many new cancer treatments, even targeted therapies, can have unexpected cardiac side effects like heart failure, hypertension, and vascular issues. Examples of drugs that cause cardiac side effects include Herceptin, angiogenesis inhibitors, and tyrosine kinase inhibitors.

•Delayed side effects : Older chemotherapies can have delayed heart effects, leading to heart disease years after treatment.

•Hormone therapy side effects : Hormone deprivation therapy (a standard treatment for breast cancer and prostate cancer) has been shown to increase the risk of diabetes, heart attacks, and sudden cardiac death, especially in observational studies.

•Monitoring for side effects: Given the increasing prevalence of heart issues, you need to be tracking your symptoms.

•Dose dependency : The risk of cardiac complications is often dose-dependent, so minimizing the effective dose of chemotherapy is important. Radiation therapy to the chest area can also increase the risk of heart disease, with each gray of radiation directly to the heart increasing the risk.

•Drugs for cardiac health also for cancer. Metformin and statins are proven to manage cardiac disease and seem to also provide anti-cancer effects. What are symptoms that may indicate you have heart-related side effects from your cancer treatment that you should pay attention to?

•Shortness of breath

•Chest pain or discomfort

•Irregular heartbeat or palpitations

•Swelling in the legs or feet

•Fatigue or weakness

•Dizziness or lightheadedness

•Decreased heart function

•High blood pressure

•Blood clots

•Artery disease

•Dizziness, lightheadedness, passing out How can you leverage this knowledge to improve your outcomes?

•Monitor: Get cardiac monitoring and management during and after cancer treatment, including echocardiograms, EKGs, and management of risk factors like hypertension and diabetes.

•Consider some drugs : Explore the potential benefits of medications like metformin, statins, and beta-blockers to mitigate cardiac risks in cancer patients.

•Follow the research : Better understand the common risk factors and genetic predispositions that contribute to both cancer and heart disease.

•Get multidisciplinary advice : Be proactive in seeking out specialists in different disciplines to manage your cardiac health. What are potential heart-protective measures, including possible adjustments to your treatment plan?

•Exercise: Incorporate a mix of cardiovascular exercise, strength training, and flexibility activities.

•Diet: Choose healthy foods.

•Healthy weight: Achieve and maintain a body mass index (BMI) within the recommended range.

•Quit smoking: Seek support from healthcare providers or smoking cessation programs to help you quit.

•Consider metformin : It can control diabetes and may have a beneficial effect on prostate cancer.

•Consider statins: Helps manage cholesterol and may also have a beneficial effect on prostate cancer recurrence.

•Adjust your treatment plan : Such as minimizing the effective dose of your chemotherapy to reduce cardiac toxicity. What should you do if you have heart-related side effects from your cancer treatment or you want to proactively protect yourself?

•Follow the "ABCDE" approach : A: assessment of risk, aspirin; B: blood pressure management; C: cholesterol management, cigarette/tobacco cessation; D: diet and weight management, diabetes prevention and treatment; and E: exercise, echocardiogram.

•Speak up: Be diligent about attending your appointments and your cardiac monitoring. Communicate any symptoms or concerns you have to your doctors.

•Follow recommendations : To manage your cardiac side effects, you may have adjustments to your cancer treatment plan, medications, or additional monitoring and testing.

•Consider preventive drugs : If recommended by your healthcare team, take medications like metformin or statins, which may help mitigate cardiac risks. How can you learn more?

•Contact Dr. Moslehi at Javid.moslehi@ucsf.edu The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. Meeting Notes KEYWORDS Cancer patient lab, cardiac issues, cardio oncology, cancer treatments, heart disease, anthracyclines, doxorubicin, cardiac monitoring, androgen deprivation therapy, immunotherapy, cardiovascular risk factors, metformin, statins, accelerated aging, NCCN guidelines. SPEAKERS Javid Moslehi (85%), Rick Davis (7%), Brad Power (7%), David Plunkett (0%) CHAT CONTRIBUTORS Hilary Elkin, Helene, Rick Davis, Roger Royse, Brad Power, Ari Akerstein, Jack Baruch, John Antonucci, David Plunkett, Jeff Dwyer, Alane Watkins SUMMARY Dr. Javid Moslehi from UCSF discussed the intersection of cancer and cardiac management. He highlighted the increasing prevalence of heart disease in cancer survivors due to improved cancer treatments, noting that heart disease now accounts for 700,000 deaths annually in the U.S. Dr. Moslehi emphasized the importance of monitoring cardiac health during and after cancer treatment, particularly with anthracyclines like doxorubicin, which can cause cardiomyopathy. He also discussed the impact of androgen deprivation therapy on cardiac risk factors and the potential benefits of metformin and statins in reducing both cardiac and cancer risks. The discussion included the need for personalized treatment approaches to manage these comorbidities. OUTLINE Introductions

•Dr. Moslehi from UCSF will discuss the intersection between cancer and cardiac issues.

•He is a cardiologist trained on the East Coast, with experience at Johns Hopkins and Brigham and Women's.

•His background is in cardiology and research, including work on kidney cancer and heart disease.

•He transitioned to cardio-oncology and established programs at Vanderbilt and UCSF. Expansion of Cardio-Oncology Program

•The UCSF cardio-oncology program focuses on cancer patients, with five cardiologists seeing patients and a research group advancing the program's mission.

•Cardio-oncology is important in the context of improved cancer treatments and longer patient survival.

•The program has established a fellowship to train specialists in cardio-oncology and immunology. Cancer Statistics and Trends

•Cancer statistics from the American Cancer Society compare new cases and deaths for various cancers.

•Lung cancer is the leading cause of cancer deaths for both males and females.

•The trend in cancer deaths over the past few decades is decreasing due to improved treatments. Discussion on Prostate Cancer Statistics

•Rick Davis questions the accuracy of prostate cancer statistics, citing an increase in de novo metastatic diagnoses.

•Dr. Moslehi acknowledges the controversy surrounding prostate cancer screening and the potential impact of USPSTF guidelines.

•He agrees that the discussion on prostate cancer screening and treatment is complex and contentious. Impact of New Cancer Treatments on Cardiac Health

•Dr. Moslehi discusses the impact of new cancer treatments on cardiac health, using Herceptin as an example.

•He explains that specific treatments like Herceptin can cause heart failure, despite being targeted therapies.

•He highlights the importance of monitoring cardiac health during and after cancer treatment.

•He mentions the role of the NCCN in introducing guidelines for cardiac monitoring following cancer treatment. Cardiac Risks of Cancer Treatments

•Dr. Moslehi explains the cardiac risks associated with anthracyclines, such as doxorubicin, and the importance of cumulative dose.

•He discusses the risk factors for cardiac issues, including age and underlying cardiac disease.

•He mentions the need for minimizing the effective dose of chemotherapy to reduce cardiac toxicity.

•He highlights the importance of understanding the cumulative dose and its impact on cardiac health. Cardiac Risks of Radiation Therapy

•Dr. Moslehi discusses the cardiac risks associated with radiation therapy, particularly in breast cancer patients.

•He references a study that calculated the risk of heart disease with each gray of radiation directly to the heart.

•He explains the interventions by radiation oncologists to minimize the exposure of the heart to radiation. Androgen Deprivation Therapy and Cardiac Risks

•There are cardiac risks associated with androgen deprivation therapy (ADT) for prostate cancer.

•A study by Nancy Keating found a significant increased risk of diabetes and heart disease with ADT.

•There is a discrepancy between clinical trial data and observational data on ADT's cardiac risks.

•Monitoring cardiac health in patients on ADT is important.

•There are potential benefits to lifestyle interventions. Immunotherapy and Cardiac Risks

•Dr. Moslehi discussed the cardiac risks associated with immunotherapy, particularly immune checkpoint inhibitors.

•He explained the revolutionary impact of immunotherapy on cancer treatment, particularly in melanoma.

•He highlighted the cardiac risks of immunotherapy, including myocarditis (inflammation of the heart muscle), and the importance of monitoring cardiac health.

•He mentioned the growing appreciation of common risk factors for both cancer and heart disease. Cardiovascular Wellness in Cancer Survivors

•Dr. Moslehi introduced the ABCDE approach to cardiovascular wellness in cancer survivors.

•He emphasized the importance of monitoring and treating common risk factors for both cancer and heart disease.

•He discussed the potential benefits of lifestyle interventions, such as metformin and statins, on both cardiac health and cancer recurrence.

•He highlighted the need for ongoing research to better understand the interplay between cancer treatment and cardiac health.

•This is medical information only. It is not medical advice. We like to arm our patients with information they can take to their medical team.

•We are a patient-led nonprofit organization, so we welcome donations, which you can do through our website, where we have a Donate button. Javid Moslehi 2:09 My name is Javid Moslehi. I'm a cardiologist by training, and I also run a research lab. I did most of my training on the East Coast. I was a resident at Johns Hopkins, and then went to Boston and trained at Brigham and Women's, which is one of the Harvard programs for cardiology. I became a cardiologist, did my fellowship, and then I went to Dana Farber. I trained with Bill Kalin, working mostly on kidney cancer, but the machinery that leads to kidney cancer. It turns out it had a fundamental role in our biology, including heart disease. I worked on that for a number of years. It was a long postdoc after I'd become a cardiologist. Somebody gave me the idea of having a clinic at Dana Farber seeing cancer patients, and I thought it would be a side job where I would just show up and maybe two patients show up, because I had always been told that if you got cancer, you're probably going to die from the cancer, and certainly you don't have to worry about heart disease. But it turned out to be the opposite. This is now more than 15 years ago. What was amazing to me was the number of therapies that were coming in place for cancer, many of which help patients. People either got cured of their cancer or lived with their cancer being on therapies. For that reason alone, the fact that people were living longer with cancer, heart disease became more prominent. This was an important, eye-opening experience for me. The other interesting thing was the number of therapies that were coming in the space for various cancers, which had definitely an impact, but which can have direct cardiovascular effects. This intersection between cardiac disease and cancer expands beyond that as what our group and others have defined. I went from the Brigham to Vanderbilt, where I started my own lab and started a program in cardio oncology. Things actually went quite well in terms of both our research program and I'll show you some of the stuff that we did, but also this area was really exploding, and so I got a call from the my current boss, Jeff Olgin, to try to set up this program in cardio-oncology here in the West Coast. I moved for the first time in my life to the West Coast. The day I got in, I'd been here a number of times for meetings, but I feel really at home. It's been two-and-a-half years, three years, that I've been in San Francisco. It’s my first time living on the west coast. I am so happy that I'm here. I'm hoping to explain to you what our program is. We have grown quite a bit.