Cancer treatment and the heart

By Sheryl M. Ness, R.N. February 18, 2015

Living With Cancer

Subscribe to our Living With Cancer e-newsletter to stay up to date on cancer topics.

Sign up now

Cancer treatments can have a significant impact on your heart, ranging from weakening of the heart muscle to heart attacks or rhythm problems. Some chemotherapy drugs have also been linked to high blood pressure.

Fortunately, heart disease associated with chemotherapy is rare and not seen with every chemotherapy drug. As new treatments are developed, short term and long term side effects including heart problems are being closely studied.

Of the current anti-cancer treatments, the most commonly monitored drugs are a class known as anthracyclines (doxorubicin, daunorubicin, others), as well as newer medications such as trastuzumab (Herceptin), which may cause weakening of the heart muscle.

The chance of heart damage from anthracyclines is related to the total amount received during your lifetime. Your doctor will carefully monitor your use. Heart weakening from trastuzumab isn't related to total lifetime dose and is often reversible.

If your doctor is considering using a chemotherapy drug that may affect your heart, you may need heart function testing before beginning treatment.

During treatment, you may need periodic heart monitoring tests. If you have a pre-existing heart condition, such as cardiomyopathy, your doctor may suggest a different type of chemotherapy.

If you experience significant problems such as unexplained shortness of breath, chest pain or irregular heartbeats during or after chemotherapy, report your symptoms immediately to your health care team.

Radiation treatment can also come with risks. If the area of your body receiving radiation includes your chest (for example for breast cancer or lymphoma), you may have an increased risk of cardiomyopathy, valvular heart disease and heart attack.

The combination of radiation and chemotherapy together can generate a considerably higher risk of heart damage. However, your doctor can take steps to reduce these risks as much as possible.

Mayo Clinic now offers a program to address heart problems associated with cancer treatment called cardio-oncology. The cardio-oncology clinic is available to evaluate people prior to cancer treatment and for others who have experienced side effects due their treatment.

Please feel free to share your thoughts related to this topic with each other on the blog.

With

Sheryl M. Ness, R.N.

Follow on Twitter: @SherylNess1

http://www.mayoclinic.org/diseases-conditions/cancer/expert-blog/chemotherapy-heart-disease/bgp-20127167/?utm_source=newsletter&utm_medium=email&utm_campaign=living-with-cancer

Why One Woman With Lung Cancer Photographed Herself Every Day For A Year

The Huffington Post  |  By Erin Schumaker

Posted: 02/24/2015 8:19 am EST Updated: 3 hours ago

• Share52
• Tweet17
• 0
• Comment27

• 

In 2013, Jennifer Glass was diagnosed with stage IIIB lung cancer. To help document her life, she took a photo every day and then, in March 2014, she set it to music and uploaded it to YouTube. Since then, the video has been viewed more than 345,000 times, by people around the world. This is her story.

How It Happened: The day I was diagnosed, it was a Saturday. The doctor called us at home and initially he said, 'You have stage IV lung cancer.' We didn’t know if it had spread to my brain and my bones. We didn’t know a lot. We just knew we were going to be in for a rough ride.

The first several months were really just about getting through the treatment. I lost my hair. I felt crummy. I didn’t think so much about what was going to happen in the long term. I just wanted to do the treatment and then find out where we were. At the end of the treatment, the tests showed that it had been effective. The tumors had shrunk. Then I went on this drug that had really profound side effects. If you saw in the video, I had a terrible facial rash. That’s one of the common side effects of that drug at the high dose. It was a few months while we played with the dose and found a way for me to tolerate it.

The turning point was really after that. Once the tests started to come back, it showed that it was going to be okay, at least for a little while. I’m not going to die this year. I had to start thinking a little bit beyond 'What do I do today for my treatment?' and start thinking, 'How do I use my time effectively -- the time that I have left?'

All of this is finding a balance between being hopeful and being accepting. Finding a balance between the very short-term view of 'Am I going to die in six months? Am I going to have a year? Two years? Five years?' You make different decisions. You make different plans. If you have a very short-term view, it’s easy to prioritize things.

When I was in the middle of my treatment, it was really easy for me to not sweat the small stuff. I was very focused on getting through and appreciating my family and telling people I loved them. When you start to feel better, the minutia creeps back. Now I’m crabby when the cable guy is late. Little things like that. But that indicates a return to normalcy.

How I Coped: The night I was diagnosed, I was getting ready for bed and taking my makeup off and looking in the mirror and I had this really strong thought: 'What am I going to see in the mirror this year? What is going to happen to my body?' I said to my husband, 'Harlan, I’d like you to take my picture tonight. And I think I want to do this every day. I want to chronicle what happens to me.' And so that’s how it started. I didn’t know what I would do with it. I just had a sense that I wanted a record of it.

We kept up with it and at the end of the year I had this visual story that was told with pictures. My brother wrote the song that’s on the video, and that was the trigger that made me think, 'I could put the pictures to his words.'

I was really overwhelmed by the response. A lot of the responses I get, the comments, are from people battling illness, but I’d say just as many are from friends or family members (and this is not just the video, but also my blog), people saying, 'You really helped me understand what my father or friend is going through. You helped us have a conversation we didn’t know how to have before.' Even though the song is in English, I’ve gotten an extraordinary response from around the world, in every language -- from Africa to Europe to Latin America.

Where I Stand: Just to be specific about the status of my illness, [being called] a survivor is a little optimistic still, at this point. I have cancer and it’s too soon to say it’s in remission, though the chemo and radiation I had and the medication I’m on is keeping it contained. It’s not spreading, but I’m still actively being treated. It’s been a year and a half now of no growth. I get tested every few months and we take it one day at a time.

My husband and I were just married when this hit, and so the first year of our marriage was all about cancer. Now we are spending our time being married. We are taking trips we wanted to take. I wouldn’t say I have a bucket list. I’ve lived a really full life I’m proud of. But we’re not putting things off. If there’s something we want to do, we do it. We spend our time together. I spend time with my step kids. I really make time for my friends.

What I Learned: Looking back at it, the most debilitating thing about a life-threatening illness is often the fear that comes with it more than the reality of the illness. People said, 'Oh, you’re going to beat this thing. You’re fearless. You’re fearless.' Well, of course, I’m not fearless, but I have found ways to fear less. If you can take fear out the equation at all, even a little bit, you can think more clearly. You make better decisions and with luck, you can find a path to peace -- some way to balance hope and acceptance.

There’s a difference between extending life and prolonging the dying process. I’m doing everything I can to extend my life. What I take issue with, is that I don’t feel that anyone else should have the right to prolong my death. I am at peace with the idea that my life is going to end. But how it ends is very frightening to me if lung cancer runs its course.

That’s why I’ve been so active and vocal about bringing end-of-life legislation to California and more broadly throughout the country. I think a lot now about quality of life, and that has to include end-of-life. If I knew I had options and didn’t have to worry about what was going to happen in those final weeks and days, my quality of life would be better. I would be able to live more joyfully and more peacefully, not having to worry about how it was going to end.

As told to Erin Schumaker. This email and interview have been edited for length and clarity.

Jennifer Glass is a writer, speaker and advocate for aid in dying. See more atjenglass.com.

Do you have a story about cancer and emotional wellness you'd like to share? Email us at healthyliving@huffingtonpost.com to share your thoughts in your own words. Please be sure to include your name and phone number.

http://www.huffingtonpost.com/2015/02/24/living-with-lung-cancer_n_6706658.html?ncid=txtlnkusaolp00000592

Gold nanotubes used to image and destroy cancer cells

By Nick Lavars

February 16, 2015

2 Comments

Pulsed near infrared light (shown in red) is shone onto a tumour (white) that is encased in blood vessels, while the tumor is imaged by multispectral optoacoustic tomography via the ultrasound emission (blue) from the gold nanotubes (Image: Jing Claussen/iThera Medical, Germany)

For some time, the potential of gold nanoparticles as a diagnostics and imaging tool has been known to scientists, but new research suggests they could prove even more useful than previously thought. A team at the University of Leeds has discovered that shaping the particles in the form of nanotubes sees them take on a number of new properties, including the ability to be heated up to destroy cancer cells.

At the heart of the approach's flexibility is a newly developed technique enabling the researchers to control the length of the gold nanotubes. The researchers say by altering how long the nanotubes are they can manipulate how they respond to different types of light.

More specifically, they can tailor the nanotubes to react to near-infrared light. To investigate its efficacy, the team administered the gold nanotubes intravenously in mice and tracked their movements using an imaging technique known as multispectral optoacoustic tomography (MSOT).

"When the gold nanotubes travel through the body, if light of the right frequency is shone on them they absorb the light," says Professor Steve Evans from the School of Physics and Astronomy at the University of Leeds. "This light energy is converted to heat, rather like the warmth generated by the Sun on skin. Using a pulsed laser beam, we were able to rapidly raise the temperature in the vicinity of the nanotubes so that it was high enough to destroy cancer cells."

The team found that the function of the gold nanotubes could be switched from regular imaging to cell-destruction mode by changing the brightness of the laser pulse. And because the nanotubes were excreted from the mouse's body, they weren't likely to create problems resulting from toxicity.

In addition to its cancer-destroying capabilities, the nanotubes also have the ability to carry drugs to the tumor site, offering another layer of flexibility. The researchers say the study is the first time the effects of the gold nanotubes have been observed in mice and are hopeful it could lead to more precise forms of treatment with reduced side effects.

"The nanotubes can be tumor-targeted and have a central hollow core that can be loaded with a therapeutic payload," says Dr James McLaughlan, one of the study's co-authors. "This combination of targeting and localized release of a therapeutic agent could, in this age of personalized medicine, be used to identify and treat cancer with minimal toxicity to patients.”

The research was published in the journal Advanced Functional Materials.

Source: University of Leeds

http://www.gizmag.com/gold-nanotubes-destroy-cancer-cells/36116/?utm_source=Gizmag+Subscribers&utm_campaign=f54618033a-UA-2235360-4&utm_medium=email&utm_term=0_65b67362bd-f54618033a-90055698

Heart Health After Cancer: A Growing Concern

Comment Now 

Follow Comments 

Nearly 15 million people are living after a cancer diagnosis in the United States. This number represent over 4 percent of the population, an astonishing figure. And a growing one, as reported last year by the ACS and outlined by the NCI’s Office of Cancer Survivorship.

As cancer patients survive longer they face additional health problems. Radiation to the chest, chemotherapy, antibody therapy and hormone changes can affect blood vessels and heart function in the short term and long, during treatment or years later. But millions affected – and their physicians – remain insufficiently mindful about the risk of heart disease.

It’s the kind of problem a person who’s had cancer, or a doctor who’s prescribed generally helpful treatment, may not want to think about.

Years ago, heart complications of cancer treatment didn’t garner so much attention says, Dr. Javid Moslehi, a cardiologist who leads a program in cardio-oncology at the Vanderbilt University School of Medicine in Nashville, TN. The emerging field involves cardiologists, oncologists, scientists and others who study the long-term effects of cancer treatment on the heart.

“In the past, people were just glad to be alive,” he said. “With so many survivors, there’s a growing need to understand how we can avoid toxic effects of treatment,” he said. “Cardiac issues are becoming central,” he said.

To promote heart health after cancer treatment, Moslehi and collaborators put forth an ABCDE plan that was published last year in Circulation. The “ABCDE” program, developed with a group including Dr. Ann Partridge at Boston’s Dana Farber Cancer Institute, lists pro-active steps a woman with breast cancer might take to prevent or lessen her chances of heart disease.

The ABCDE acronym is a bit more complicated than its five letters might suggest. The gist of the proposed program, published here, is this:

A is for Awareness of the risk of heart disease (and Aspirin, which some might take upon consultation with a doctor);

B is for Blood pressure – which might need monitoring;

C is for Cholesterol – to keep it low (and Cigarettes – to stop smoking, and your author’s preferred “C”);

D is for Diet – keeping your weight down is good for survival (and for Dose – whether it’s chemo or radiation, how much you get affects risk; and for Diabetes – averting it if possible, controlling it if you have the condition);

E is for Exercise – Do it! (if you’re able; and for Echocardiogram, this images how well the heart is functioning; it’s not a bad way to keep an eye on things if you’re on a drug, like Herceptin among others, that might need be stopped, or the dose adjusted).

The ABCDE take-away is that there are steps a cancer patient might take to deter heart disease. While this initial plan focuses on women who've had breast cancer, the largest cohort of survivors, the principles of preventing or minimizing cardiac problems might help those with other cancer types. Prospective studies are needed.

For the more than 3 million U.S. women who have had breast cancer, the possibility of heart damage from is quite real. Apart from heart disease from chemotherapy drugs and radiation, there may be an augmented risk after early menopause. Natural estrogens, which are deliberately blocked by some types of breast cancer treatment, may be cardio-protective – and were thought to explain why men are more prone to heart disease than women.

February is Heart Health Month. (image adapted, credit: Billie Ward via Flickr)

After breast cancer treatment, women should be mindful of heart disease symptoms, which can be subtle. The unfortunate reality is that many doctors, nurse practitioners and others fail to adequately consider the possibility of vascular and other diseases of the heart when evaluating healthy-seeming and non-elderly women.

So the need for greater awareness of risk applies to physicians, too, especially as patients may move or lose access to their oncologist who knows what they received years or decades earlier. Patients aren’t perfect, either; some “forget” or might not remember if they received radiation 25 years ago after a lumpectomy.

As new drugs become available, the side effects of each treatment, and combinations, should be more carefully weighed. “The FDA is becoming much more focused on cardiovascular safety of cancer drugs,” Moslehi said.

For instance, in October 2013 the FDA pulled back on approval of ponatinib (Iclusig, Ariad Pharmaceuticals), a drug used for treating CML, a chronic form of leukemia. The main reason for the FDA’s switch, which turned yet again after advocates and doctors pushed for continued access to the drug was concern over its vascular toxicity including effects on the heart.

“The CML drug was transiently taken off the market because it wasn’t deemed essential,” Moslehi said. But in some cases of CML, it turns out that ponatinib is the only drug that works. Now the drug is back on the market. But there’s little data on how to avoid its cardiac complications, he noted. Radiation has been a major culprit in accelerating heart disease, Moslehi said.

In recent decades, radiation oncologists have developed methods to protect the heart during treatment. It’s better now than it was in the 1980s and even the 1990s, he suggested. “It may be a greater problem for patients who received radiation a long time ago.”

Old chemotherapy drugs like Adriamycin (the “red devil”) and its chemical relatives are long-known for their capacity to harm a patient’s heart. Years ago, oncologists knew to order serial heart assessments before and after every few cycles of these drugs, to make sure the infusions were doing more good than harm.

The Google-able list of heart toxicity is scary, wide and long, enough to depress almost anyone who’s had treatment. If you look, you’ll find: Recent reports confirm the damaging potential of some of the earliest and most widely-used cancer medications, like 5-fluorourcacil (5-FU). Drugs like taxol can slow the heart and more. Cyclophosphamide delivers its own set of concerns, especially if it’s given at high doses. Herceptin, a drug that has transformed the prognosis (from bad to good) for countless patients, has well-documented cardiac toxicity.

The list goes on, but I’ll stop here. It’s enough to scare the wits out of a reader or person like me who’s trying to move forward with a healthy life after cancer treatment. The ways that cancer drugs cause heart damage are diverse, Moslehi said in an interview with the American College of Cardiology’s CardioSource. Old chemotherapies and radiation are toxic, but so are many newer drugs, he emphasized: angiogenesis inhibitors can cause high blood pressure and clots; tyrosine kinase inhibitors cause vascular disease; one class of agents, called HDAC inhibitors, cause abnormal heart rhythms; other drugs called mTOR inhibitors, lead to metabolic changes that affect the heart.

“It’s complicated,” he told me. “Unfortunately, we have very little idea of what the right assessment before, during and after treatment should be.”

“Anthracyclines are still used for Hodgkin’s, breast cancer and lymphoma. They have lots of cardiac toxicity,” Moslehi told me by phone. “In the past this was not an issue because there were no other therapies to give.”

He and other cardio-oncology investigators are studying the molecular changes that lead to heart problems after cancer. The goal is to find ways to predict and prevent heart disease in people who otherwise benefit from cancer drugs. Ideally the drugs and doses might be selected, or avoided, in each case with information about the patient’s tumor and cardiac risk.

“The whole reason we have this problem in the first place is that the treatments for cancer are so effective, Moslehi said. “The last thing we want to do is take away good treatments.”

–

To receive my articles, follow me here at Forbes.  I’m on Twitter @ElaineSchattner. For my public updates on Facebook hit the “follow” button.

http://www.forbes.com/sites/elaineschattner/2015/02/23/heart-health-after-cancer-a-growing-need-for-care-and-research-in-cardio-oncology/