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Chemotherapy-Induced Cardiomyopathy- How Big is the Problem?

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My personal belief is that chemotherapy-induced cardiomyopathy is a large and growing problem for cancer patients- especially pediatric and AYA cancer survivors. Let me tell you why.

Conventional oncology spends little time and even less money learning about the long-term and late stage side effect of the toxicity they prescribe. That is not necessarily a criticism. The job of your average oncologist is to treat your cancer. Period.

I am a cancer survivor. I developed chemotherapy-induced cardiomyopathy in late 2010 approximately 15 years after I had the cardiotoxic chemotherapy regimens  that damaged my heart.

I developed a host of heart problems as well as atrial fibrillation aka AFib as a result of four different known cardiotoxic chemo regiments that I underwent in the normal course of my conventional treatment.

What is chemotherapy-induced cardiomyopathy? How much of a problem is the short, long-term and late stage side effect?

Short-Term Side Effects

1. Immediate Cardiac Dysfunction:

  • Acute Toxicity: Some chemotherapy agents, such as anthracyclines (e.g., doxorubicin), can cause acute cardiotoxicity, leading to temporary reductions in heart function. Symptoms may include arrhythmias or acute heart failure, but these are less common compared to long-term effects.

Long-Term Side Effects

1. Chronic Cardiomyopathy:

  • Progressive Heart Damage: Chemotherapy-induced cardiomyopathy often manifests as a progressive condition, where the initial damage to heart cells leads to long-term deterioration of cardiac function. This can result in dilated cardiomyopathy, where the heart becomes enlarged and weakened.
  • Asymptomatic Stage: In the early stages, patients might not exhibit symptoms even though heart function is compromised. Regular monitoring through echocardiograms and biomarkers like troponins and BNP (B-type natriuretic peptide) is crucial for early detection.

2. Congestive Heart Failure:

  • Symptoms Development: Over time, patients can develop symptoms of heart failure, including shortness of breath, fatigue, and edema (swelling), which significantly impact their quality of life. This is a common presentation in long-term survivors of cancer who were treated with cardiotoxic agents.

Late-Stage Side Effects

1. Advanced Heart Failure:

  • Severe Cardiomyopathy: In the late stages, CIC can lead to severe and irreversible heart failure. The heart’s pumping ability is significantly reduced, often requiring complex medical management or advanced therapies like heart transplants in some cases.

2. Increased Mortality:

  • Reduced Survival Rates: Late-stage heart failure due to CIC is associated with increased mortality. Cancer survivors with severe cardiomyopathy have a higher risk of death from cardiac causes compared to those without cardiotoxic effects.

Risk Factors

Several factors influence the likelihood and severity of chemotherapy-induced cardiomyopathy:

  • Type of Chemotherapy: Anthracyclines (e.g., doxorubicin) and newer agents like trastuzumab (used in HER2-positive breast cancer) are well-known for their cardiotoxic potential.
  • Cumulative Dose: Higher cumulative doses of cardiotoxic agents increase the risk of developing cardiomyopathy.
  • Pre-existing Conditions: Patients with pre-existing cardiovascular diseases, hypertension, diabetes, or those who have undergone radiation therapy to the chest are at higher risk.
  • Age and Gender: Older patients and females may be more susceptible to CIC.

Management and Prevention

1. Cardio-Protective Strategies:

  • Medications: ACE inhibitors, beta-blockers, and other heart failure medications can help manage symptoms and improve outcomes.
  • Dose Limitation: Reducing the cumulative dose of cardiotoxic chemotherapy agents or using alternative medications when possible.
  • Monitoring: Regular cardiac monitoring before, during, and after chemotherapy helps in early detection and management of cardiotoxicity.

2. Emerging Therapies:

  • Novel Agents: Research is ongoing to develop chemotherapy agents with reduced cardiotoxicity.
  • Biomarkers: Advances in biomarkers and imaging techniques are improving the early detection of cardiac damage, allowing for timely intervention.

Though chemotherapy-induced cardiomyopathy is well documents as a late stage side effect, few doctors believe that my heart problems resulted from chemo.

Consider most if not all cancer patients who undergo chemotherapy, sustain at least some damage to their heart. And that damage may rear its ugly head during chemo, months after chemo, or like me, years after their cardiotoxic chemotherapy.

According to research, there were 18.1 million cancer survivors alive in the U.S. in 2022. Consider that a tiny portion of these cancer survivors are like me. They underwent cardiotoxic chemo yet showed no signs at the time of administration.

man hand holding his nutritional supplemets, healthy lifestyle background.

Consider if just 1% of those 18 million cancer survivor develop heart damage years after their chemotherapy. This means that approximately 18,000 cancer survivors will develop heart failure someday.

My solution? I take heart healthy supplements, eat a heart healthy diet, exercise mildly- essentially living a heart healthy life. And I don’t take any conventional heart meds such as metoprolol.

I’m not a cardiologist. I don’t know if everyone will respond as well as I did. But cardio-oncology should at least consider evidence-based non-conventional heart health therapies.

Are you a cancer survivor? Have you undergone any cardiotoxic therapies? If you would like to learn more about evidence-based, heart healthy therapies email meat David.PeopleBeatingCancer@gmail.com


David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Chemotherapy-induced cardiomyopathy: a review of literature on clinical status and meta-analysis of echocardiographic diagnosis and the value of cardioprotection therapy

“Cancer and cardiovascular (CVD) diseases are two separate disease entities but share many different clinicopathologic characteristics [1]. Intensive chemotherapy improves longevity in cancer patients but increases the risk of developing chemotherapy-induced cardiomyopathy (CCM), also known as chemotherapy-induced cardiotoxicity (CIC)…

However, the prevalence is significantly higher in oncology studies, which report more than 50% of cancer survivors exhibit some degree of cardiac dysfunction between 10 and 20 years after chemotherapy and 5% of them go on to develop clinically overt HF [24]. In support, Silber et al. [25] report more than 60,000 cancer patients receive treatment for CCM annually in the Unites States (U.S), suggesting the overall CCM incidence maybe underestimated in literature…

Prognosis: In comparison with other more frequently encountered forms of cardiomyopathies, ANT-induced cardiomyopathy has an unfavorable prognosis with a two-year mortality rate of up to 60% [21,42,72] as well as refractory to conventional therapy.

However, a majority of evidence on the natural history of CCM and its therapy are anecdotal or based on findings from older studies, in which standard therapy was the administration of digoxin and diuretics [42,72].

In addition, there is a paucity of clinical trials examining response to therapy of CCM-associated HF as well as the efficacy of angiotensin-converting enzyme inhibitors (ACE-I) and β-blockers in the treatment of CCM-associated HF.

Further, limited data on treated and untreated CCM patients has undermined the understanding of prognostication of CCM. As a result, evidence-based recommendation for clinical management of cancer survivors with symptomatic and asymptomatic HF are lacking, which has contributed to the absence of universally accepted clinical guidelines of CCM [24].



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