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I'm lucky, and I know it. In 1984, I was treated for testicular cancer with a then-revolutionary new cocktail of medications known as PVB (the platinum-based drug cisplatin plus vinblastine and bleomycin). Only a few years earlier, close to 100 percent of those diagnosed with "my" kind of cancer died, most of them young men between the ages of 15 and 35. PVB flipped the odds, and after five years, I was deemed cured.
What I didn't know was there would be a health cost to that cure.
According to a 2021 study published in the American Journal of Cancer Research, "Cardiotoxicity has emerged as a major side effect of anticancer treatment and can present both acutely during treatment and chronically even years after treatment has been completed."
In other words, the cisplatin that saved my life is now associated with a higher risk of cardiotoxicity, which can include cardiomyopathy, heart attack, coronary artery disease, heart failure, heart valve disease and arrhythmias.
Other cancer treatment drugs now known to do the same include, but are not limited to, Adriamycin, often used to treat leukemia, lymphoma, breast cancer, sarcoma and multiple myeloma; Herceptin (trastuzumab) used to treat breast cancer, stomach cancer and cancer of the gastroesophageal junction (which is where your food pipe connects to your stomach); and carboplatin (a less toxic form of cisplatin) frequently used to treat ovarian, bladder, head and neck, lung and cervical cancer - and sometimes testicular cancer.
According to the Cleveland Clinic, it's hard to pin down the prevalence of cardiotoxicity in adult cancer survivors. According to its website, up to 20 percent of this population may develop heart problems.
Brant Inman, a surgeon who focuses on bladder, kidney and testicular cancers at the Schulich School of Medicine & Dentistry, Western University, in Ontario, Canada, said, "We're increasingly noticing, especially in younger patients who have many years of life left if cured, who then experience complications of the medical treatments we gave to [treat] them."
Cardiotoxicity is also insidious. Anne Blaes, a professor of hematology and oncology at the University of Minnesota who has a special interest in the later-in-life effects of cancer treatment, told me that heart complications can develop years, if not decades, after cancer treatment, posing special risks for people like me who are 50-plus.
"It's more than just age at time of the cancer, though - it's the kind of cancer, and how it's treated," she said.
As new cancer treatments continue to be developed, we may be planting the seeds of new long-term effects, she said. "Among the many new therapies, there's a growing concern about [the after effects]immunotherapy and what this does to atherosclerosis," or thickening or hardening of the arteries, Blaes said. "We simply don't know yet."
Who is most at risk for heart disease after cancer?
The Cardiovascular Risk Calculator produced by the Childhood Cancer Survivor Study predicts the risk of several heart issues by age 50 among survivors of childhood cancer. In general, the most at-risk cancer survivors include:
• Individuals 60 years old and over, young children and women;
• People who were treated with high doses of anthracyclines, high-dose radiation to the chest, or both, and have a history of smoking, high blood pressure, diabetes, obesity or heart problems.
What can you do to reduce risk of post-chemo heart trouble?
Blaes recommends developing an individual plan tailored just for your circumstances. For instance:
• If you don't know, find out what drugs you received. If you had radiation, which parts of your body were treated? If you don't see an oncologist any more, many cancer treatment clinics have survivorship programs that will get your records and create a care plan. Or for a personal plan tailored just for you, she recommends Oncolink, for no charge, though you must know your previous treatment history to use it.
• Make sure all your doctors know your medical history and risk factors, which include blood pressure, glucose and cholesterol levels, chronic inflammation, viral exposure, tobacco use, obesity and physical activity. I was surprised when she explained that the risk of cardiovascular incidents was 40-fold higher if you had high blood pressure, even though you had these drug exposures compared to someone without high blood pressure with the same exposures. For instance, she fears that many primary care doctors will see a blood pressure reading of 140 over 90 and say, "It's fine." "It's not fine. Not when you've had these drugs before."
• For those seeking more detailed and customized information about specific cancer treatments and heart disease, Blaes recommends the American College of Cardiology's Cardiosmart tool.
If I am lucky, so, too, is Susan Gambucci, a 59-year-old retired teacher who was diagnosed with non-Hodgkin lymphoma in 1982 at age 17. As a teen she was treated with four rounds of chemotherapy and radiation to the chest. Her doctor explained that she'd have fertility issues and that some day, "in the way, way future," she might need a heart valve replacement.
"They asked me, ‘Do you want to take the risk?' Yeah, I do! I'm a junior in high school, facing imminent death."
Three decades later, Gambucci needed her aortic valve replaced followed by a triple bypass. Both her mitral and tricuspid heart valves now leak severely, causing shortness of breath, fatigue, lightheadedness and a rapid fluttering heartbeat. A more comprehensive work-up not long ago revealed she needed a heart transplant, though she's considered too high risk a patient to qualify for one.
Her oncologist believes the chemotherapy and radiation she received as a teen are likely the cause of her heart issues. When we spoke recently, she told me she knows that her heart disease is only going to get worse. Still, she noted that a doctor at the Mayo Clinic told her, "You're lucky to have these problems," meaning she's lucky to be alive.
Gambucci then asked me, "Do you understand what I'm saying?" "Yes, I do," I told her. Meaning yes, I, too, know how lucky I am. And, that nothing comes without a price.
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