Treating breast cancer, saving the heart

Cardio-oncologists help keep hearts healthy during and after cancer treatment

My work at the University of Michigan Frankel Cardiovascular Center focuses on preventing and minimizing heart damage that can be caused by cancer treatment. It’s a risk faced by more than 2 million breast cancer survivors who have had either chemotherapy or radiation.

Dr. Elina Yamada is a member of the cardio-oncology team at the University of Michigan.

Dr. Elina Yamada is a member of the cardio-oncology team at the University of Michigan.

I recently had the chance to talk to a group at Gilda’s Club of Metro Detroit, a community that provides emotional and social support for adults, teens and children living with any kind of cancer, and in October they turned their attention to breast cancer.

Here are some of the common questions I hear from breast cancer survivors:

What’s my risk?   – Various cancer treatments can interact with the heart. Chemotherapy drugs, such as anthracyclines, designed to kill cancer cells can also harm heart muscle cells, causing a condition called cardiotoxicity. The risk can be low or high depending on the drug. Radiation therapy to the chest can lead to thickening or scarring of heart structures, such as the valves or pericardium (membrane surrounding the heart), and also affect the heart vessels, causing heart attacks. This could impact left-side breast cancer patients.

What kind of heart problems I can develop? Heart problems may develop during, or even years after cancer treatment. Cardiotoxicity can cause heart failure, high blood pressure, low blood pressure, heart attacks, irregular heartbeat, slow heart rate, or fluid around the heart. Radiation can cause heart valve disease, heart attacks, and thickening of the lining around the heart.

Is there anything I can do to prevent them? If you have cancer and want to avoid heart problems in the future, I recommend:

  • low-cholesterol diet to avoid developing blockages in the heart vessels
  • low-salt diet to avoid developing high blood pressure
  • Get daily exercises, such as walking at least 15 to 30 minutes, as tolerated
  • Avoid smoking and drinking alcoholic beverages
  • Maintain healthy weight to avoid obesity and diabetes which increase your cardiac risks

What symptoms should I worry about?  Symptoms caused by cardiotoxity can be common to the ones caused by cancer itself or treatment, such as fatigue, shortness of breath and leg swelling. In general, patients should tell their doctor if they have shortness of breath, chest pain, heart palpitations, fluid retention in the legs, distension of the stomach, dizziness or fainting. The Cardiologist should be able to examine you and run tests to determine if they are caused by heart problems or not.

Can I wait to treat my heart problems? Beating cancer is the first priority for women with breast cancer. Preventing and treating heart problems from cancer treatment can be coordinated with your Oncologist, so that you can conclude your cancer treatment. The goal of our Program is to ensure that breast cancer survivors have a healthy heart to enjoy the rest of their lives.


 

Frankel-informal-vertical-sigThe Cardio-Oncology Program at the University of Michigan Frankel Cardiovascular Center treats patients with cardiac tumors and collaborates with cancer specialists to prevent and minimize heart damage caused by chemotherapy and radiation.

How to Cope with Radiation Therapy Side Effects

Radiation therapy treats cancer by using high energy to kill tumor cells.  Many people who get radiation therapy have skin changes and some fatigue.  Side effects vary from person to person; depend on the radiation dose, and the part of the body being treated. Some patients have no side effects at all, while others have quite a few. There is no way to predict who will have side effects.

Skin changes may include dryness, itching, peeling, or blistering. These changes occur because radiation therapy damages healthy skin cells in the treatment area.

Fatigue is often described as feeling worn out or exhausted.

If you have bad side effects, the doctor may stop your treatments for a while, change the schedule, or change the type of treatment you are getting.

Depending on the part of your body being treated, you may also have:

  • Diarrhea
  • Hair loss in the treatment area
  • Mouth changes such as soreness, dryness and difficulty swallowing (if radiation to head and  neck area)
  • Nausea and vomiting
  • Sexual impact (tenderness and soreness of genital organs if radiation to this area)
  • Blood count changes

Most of these side effects go away within two months after radiation therapy is finished.

Late side effects may first occur six or more months after radiation therapy is over.  Late side effects may include infertility, joint problems, lymphedema, mouth problems, and secondary cancer. Everyone is different, so talk to your doctor or nurse about whether you might have late side effects and what signs to look for.

What can you do to take care of yourself during treatment?

  • Be sure to get plenty of rest. You may feel more tired than normal.
  • Eat a balanced, nutritious diet. Depending on the area of your body getting radiation (for example, the belly or pelvic area), your doctor or nurse may suggest changes in your diet.
  • Take care of the skin in the treatment area. If you get external radiation therapy, the skin in the treatment area may become more sensitive or look and feel sunburned. Ask your doctor or nurse before using any soap, lotions, deodorants, medicines, perfumes, cosmetics, talcum powder, or anything else on the treated area.
  • Do not wear tight clothes over the treatment area. This includes girdles, pantyhose, or close-fitting collars. Instead, wear loose, soft cotton clothing. Do not starch your clothes.
  • Do not rub, scrub, or use adhesive tape on treated skin. If your skin must be bandaged, use paper tape or other tape for sensitive skin.
  • Do not put heat or cold (such as a heating pad, heat lamp, or ice pack) on the treatment area.
  • Protect the treated area from the sun. Your skin may be extra sensitive to sunlight.   Ask your doctor if you should use a lotion that contains a sunscreen.

Did you experience any side effects from your radiation treatment?  What did you do to cope?  Please feel free to share any tips to help others.

Resources

U-M Department of Radiation Oncology

U-M Caring for Yourself after Radiation Therapy

National Cancer Institute, Radiation Therapy and You:  Support for People With Cancer

What’s the fallout: U-M radiologist answers questions about commonplace radiation exposure

For some cancer survivors, commonplace exposure to radiation induces pangs of worry. Will the chest X-ray ordered by a family doctor or a trip through the airport’s new security scanner increase your chance of developing a secondary cancer? What can you do to reduce your risks?

In the latest issue of Thrive, the University of Michigan Comprehensive Cancer Center’s patient publication, we talked with Ella Kazerooni, M.D., U-M professor of radiology, about what people with cancer should know about everyday radiation exposure. Find out what she had to say.