Cardio-oncology is a multidisciplinary specialty aimed at managing and preventing cardiovascular disease in cancer patients and survivors.[1]
My need for cardio-oncology is so yesterday. As in 25 plus years ago yesterday. I am a long-term multiple myeloma survivor. I developed chronic atrial fibrillation (afib) in late 2010 and chemotherapy-induced cardiomyopathy shortly thereafter. Today I need cardio-oncology. I need to figure out my therapy plan and prognosis for my heart issues…
The essay linked and excerpted below by Dr Michael Fradley does a pretty good job of summarizing the issues faced by cancer survivors like me.
I was diagnosed with an incurable blood cancer in early 1994. I followed every direction given to me by
- Dr. Levitan,
- Dr. Berger,
- Dr. Cooper
and even by Dr. Lazarus. Unfortuneately, those directions included high doses of adriamycin, cytoxan, busulfan and melphan. I singled out those chemotherapy regimens because they are all known to be cardiotoxic aka damage my heart. The damage they caused my heart was exacerbated for two reasons:
- all administered within a 10 month time-frame
- each of the cardio-toxic chemotherapies was given at a high-dose
And they were four of the chemotherapy regimens given to me by my team of oncologists trying to… In hindsight, I’m not sure what they were trying to do. I never acheived remission. My lesions all continued to grow.
I developed several other short, long-term and late stage side effects. About 3 1/2 years from my original cancer diagnosis my oncologist, Anne Rassiga, M.D. told me, “there’s nothing more we can do for you.” And start to finish, I, along with my insurance company, paid University Hospitals over $250,000.00 dollars. So what was the hospital trying to do?
I mean, other than make money?
Skip ahead 15 years. In the fall of 2010 I developed chronic atrial fibrillation. Meaning my heart went out of normal sinus rhythm. Which isn’t as bad as it sounds. According to research, a person like me can live a relatively normal life with chronic afib.
(Ed Note: as of 4/17/2020 (today) I am still in chronic Afib, take no meds, keep my BP, weight, cholesterol, etc. at or below normal levels.)
The reason why I need a cardio-oncologist is because afib is a symptom. An indicator of something more serious. Which brings me to why I desperately need a person who can tell me what my
- afib,
- enlarged aorta,
- enlarged left atrium,
- enlarged aortic root,
can tell me about my late stage heart damage.
Have you undergone cardiotoxic chemotherapy? What is your prognosis? How do you manage your symptoms?
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
Dr Michael Fradley discusses the cardiac implications beyond anthracyclines and heart failure
“Despite these advancements, cardiovascular toxicity is a commonly observed complication of many of these treatments. As a result, the field of cardio-oncology has developed at a rapid pace. Cardio-oncology is a multidisciplinary specialty aimed at managing and preventing cardiovascular disease in cancer patients and survivors.[1]
Initially, cardio-oncology was focused on cardiomyopathy and congestive heart failure associated with anthracyclines, a class of chemotherapeutics used to treat a variety of cancers including breast, sarcoma, leukaemia, and lymphoma.[2] As the field of cardio-oncology has grown, there is increased recognition that cardiotoxicity is not limited to just anthracyclines and heart failure; instead novel cancer therapeutics are associated with a variety of cardiac complications including vascular disease, accelerated hypertension, and arrhythmias…
Nevertheless, these treatments often have off-target effects leading to significant cardiac toxicity including stroke, myocardial infarction, accelerated hypertension and arrhythmias that can limit their use in some patients ( Table 1 )…
There is increased focus on the vascular toxicities associated with certain TKIs and IMiDs primarily used to treat chronic myelogenous leukaemia (CML) and multiple myeloma (MM)…
The IMiDs such as thalidomide, lenalidomide, and pomalidomide which are used primarily to treat multiple myeloma and AL amyloidosis all demonstrate increased rates of venous thromboembolism. Furthermore, multiple myeloma patients are at higher risk of arterial thrombo-embolic events regardless of IMiD exposure, though rates are even higher with the use of lenalidomide.[10]The incidence of myocardial infarction (MI) and stroke is 1.98 and 3.4%, respectively with the use of lenalidomide and dexamethasone compared to 0.57 and 1.7% with dexamethasone alone.[10,11] As a result, lenalidomide carries a black box warning for MI and stroke…
Patients receiving IMiDs frequently receive antithrombotic prophylaxis against venous thromboembolism (VTE) however there are no clear recommendations regarding the choice of therapy or guidelines regarding arterial thrombo-embolic prevention…[10]
With the changing landscape of cancer therapeutics, patients are living longer and in many cases surviving their malignancy. Despite these advances, cardiovascular toxicity remains a significant cause of morbidity and mortality in cancer patients and survivors and the field of cardio-oncology has developed to meet the needs of this growing patient population. While the cardio-oncologist must still be familiar with anthracyclines and other traditional chemotherapies, it is evident that there is a shifting emphasis to targeted and immunotherapies in the treatment of many cancers. Cardiovascular complications are no longer limited just to heart failure, and cardio-oncologists must be familiar with the wide variety of cardiotoxicities associated with these novel agents to ensure the health and safety of their patients…”
