Certain types of chemotherapy can lead to heart damage. However, patients whose heart’s pumping function decreases, for example, often do not notice this immediately. This emerges from UMC Utrecht research by Janine Kamphuis on which she received her doctorate on Nov. 12. By the time these patients do experience heart problems, the ailment is more difficult to treat.
Cardio-oncology is a new field that focuses on the side effects of cancer treatment on the heart. These side effects can include arrhythmias, inflammation of the pericardium and damage to heart valves or coronary arteries. Whether a patient is at risk for these side effects depends primarily on the type of cancer treatment. One of the main side effects of chemotherapy is damage to the heart muscle, which can lead to decreased pump function. With a decrease in pump function, heart failure may eventually develop.
Janine explains that certain types of chemotherapy and immunotherapy in particular, including treatment with anthracyclines and trastuzumab, increase the risk of heart damage. “Anthracyclines are mainly used to treat breast cancer, lymphoma, acute leukemia and certain types of childhood cancers. Trastuzumab is primarily used to treat HER2 positive breast cancer.”
Previous studies have shown that treatment of heart damage is most successful when it is started when there is a decline in pump function. This early deterioration does not lead to symptoms in the majority of patients and is therefore often not noticed early without monitoring. Often patients do not develop symptoms of heart failure such as shortness of breath, fatigue and fluid retention until months or even years later. If treatment with heart failure medications is not started until then, the chances of success are lower.
To be able to detect heart damage early and thus improve the quality of life of patients with cancer in both the short and long term, a special cardio-oncology outpatient clinic was established at UMC Utrecht in 2015. Here, care is provided to patients who have an increased risk of developing heart damage due to the cancer treatment they have undergone. “At this outpatient clinic, we mainly see patients whom we assess to be at high risk of heart damage. The risk assessment is now done based on the type of cancer treatment a patient receives, age and presence of risk factors for cardiovascular disease such as high blood pressure.” The thesis reveals that current risk assessment is not yet optimal. “There are patients who develop severe heart damage despite the risk of heart damage being estimated to be low. Better risk assessment is critical to be able to offer the care of this outpatient clinic to patients who can benefit most.”
To improve risk estimation in the future, Janine has set up, among other things, the Cardio-Oncology Registration (ONCOR). In this registry, multiple hospitals in the Netherlands collect data from patients who have received cardio-oncology care.
Janine does not think it makes sense to regularly screen all patients treated with anthracyclines or trastuzumab. “The point is to identify those patients who get heart damage in a timely manner. Fortunately, the vast majority do not get it. Therefore, there is no need to burden the entire group with additional checks on top of all the tests and treatments patients already have to undergo because of the cancer. Good care in the right place, that’s what we should strive for.”
Janine Kamphuis received her doctorate from Utrecht University on Nov. 12. The title of her dissertation is: Stepping stones to improve cardio-oncological care
