Surviving Cancer Shouldn't Cost You Your Heart: A New Era of Cardio-Oncology

By Subodh K. Agrawal, M.D., F.A.C.C.
Athens Heart Center & Specialty Clinics

Few moments in medicine are as emotionally charged as telling a patient that they have cancer. The first reaction is usually shock, followed quickly by the urgent question: “What do we do next?” The focus immediately shifts to the oncologist, the treatment plan, and how quickly therapy can begin.

After more than thirty years in cardiology, I have come to recognize another important question that often gets overlooked during those early conversations. While patients and physicians concentrate on defeating cancer, very few pause to ask what the treatment might be doing to the heart.

Cancer therapies have improved dramatically in recent decades. Drugs that were once experimental are now saving countless lives. Survival rates for many cancers are higher than they have ever been. This progress is something every physician celebrates. At the same time, however, we have learned that some of these life-saving treatments carry a cost that may not appear until years later.

I have seen patients who successfully beat cancer only to return to the clinic with heart failure, rhythm disturbances, or severe cardiomyopathy. These are not rare cases. They are a growing reality in modern medicine. As more people survive cancer, we are also seeing a rise in cardiovascular complications related to cancer therapy.

This is the reason the field of cardio-oncology has become so important.

Cardio-oncology focuses on protecting the heart before, during, and after cancer treatment. The goal is not to interfere with oncology care but to support it. When cardiologists and oncologists work together early in the treatment process, we can often prevent the type of cardiac damage that used to be discovered only after it became irreversible.

One of the major concerns involves chemotherapy drugs known as anthracyclines, such as doxorubicin. These medications are extremely effective against certain cancers, but they can weaken the heart muscle in some patients. Targeted therapies like trastuzumab, which are widely used in breast cancer treatment, can also affect cardiac function.

The medical term for this problem is cancer therapy induced cardiotoxicity. In simple terms, it means that a drug intended to destroy cancer cells can also place stress on the heart. Sometimes the damage develops slowly and quietly. A patient may feel perfectly well while subtle changes are already taking place inside the heart muscle.

Research from the National Cancer Institute and the National Institutes of Health has highlighted this growing challenge. As cancer survival improves, managing the long term cardiovascular health of survivors has become an increasingly important part of patient care.

The first step in addressing this problem is something surprisingly straightforward. It starts with evaluating the patient’s heart before chemotherapy begins.

When I see a patient who has recently been diagnosed with cancer, I want to understand their cardiovascular baseline. Do they already have high blood pressure? Is there a history of heart disease in the family? Are cholesterol levels elevated? Has the patient ever experienced symptoms such as shortness of breath, palpitations, or unexplained fatigue?

This evaluation helps us understand how resilient the heart may be when exposed to certain therapies. It also gives the oncology team valuable information when making treatment decisions.

Another development that is changing how we approach these cases is pharmacogenomic testing. Medicine is moving steadily toward a more individualized approach, and oncology is leading that shift.

Researchers have identified specific genetic variations that appear to influence how a patient responds to certain chemotherapy drugs. Variants involving genes such as SLC28A3 and RARG have been associated with a higher risk of anthracycline related cardiotoxicity.

In practical terms, this means we may be able to predict whether a patient’s heart is more vulnerable to damage from a particular treatment. If that risk is identified early, oncologists and cardiologists can work together to adjust therapy, consider alternative medications, or introduce protective strategies.

Monitoring also plays a critical role once treatment begins. Cardiac imaging allows us to detect early changes in heart function long before a patient notices symptoms. One of the most useful tools is echocardiography, particularly techniques that measure global longitudinal strain. These measurements can reveal subtle weakening of the heart muscle at a stage when intervention is still possible.

Blood tests can also provide important clues. Biomarkers such as troponin may rise when the heart is under stress, giving physicians another opportunity to identify potential problems early.

None of these strategies are meant to create fear around cancer treatment. The intention is exactly the opposite. Patients should feel confident that their medical team is looking at the whole picture, not just the tumor that appears on a scan.

Cancer care has evolved far beyond the idea of simply destroying malignant cells. Today the focus is on survivorship and long term quality of life. A patient who defeats cancer deserves to enjoy many healthy years afterward without facing preventable cardiovascular disease.

Organizations like the American Heart Association have emphasized the importance of collaboration between cardiologists and oncologists as the number of cancer survivors continues to grow. Protecting heart health is becoming an essential part of comprehensive cancer care.

For patients, the message is simple. If you or someone you love is preparing to begin chemotherapy, it is reasonable to ask about cardiac evaluation and monitoring. These conversations are becoming a normal part of modern cancer treatment.

Surviving cancer is a remarkable achievement. My belief, after decades of working with patients and colleagues across multiple specialties, is that survival should not come at the cost of long term heart health.

With the right collaboration and careful monitoring, we can help ensure that beating cancer does not create a second battle years later.

Sources

National Cancer Institute
https://www.cancer.gov

National Institutes of Health
https://www.nih.gov

American Heart Association
https://www.heart.org