Selected Podcast
How Can Cancer Affect Your Heart?
Heart disease and cancer are leading causes of death in the United States. How are they linked and what steps can you take to prevent them? Learn from cardio-oncologist, Dr. Dipan Desai of UM Upper Chesapeake Health, more about how these diseases can affect you.
Featured Speaker:
Dipan Desai, MD
Dr. Dipan Desai completed medical school at the Philadelphia College of Osteopathic Medicine and his internal medicine residency at Geisinger Medical Center in Danville, Pennsylvania where he was chief resident. He did a fellowship in cardiovascular diseases at New York Hospital Medical Center in Queens. He is board certified in internal medicine, cardiology, nuclear cardiology and cardiac computed tomography. Transcription:
How Can Cancer Affect Your Heart?
Maggie McKay (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach so you have everything you need to live your life to the fullest.
This episode is sponsored by the university of Maryland cancer network
I'm Maggie McKay. My guest today is Dipan Desai, a Cardiologist with Upper Chesapeake Health with a special interest in cardio-oncology. Thank you so much for being here, Doctor.
Dipan Desai, MD (Guest): Thank you for having me. I really appreciate the time.
Host: Absolutely. We're going to discuss how cancer can affect your heart. So, cardiovascular disease and cancer are leading causes of death in the US. Are they linked in any way?
Dr. Desai: So, we've found that many people who have treatment for cancers can develop cardiovascular effects. There's definitely issues with damage to the heart valves, damage to the heart muscle, narrowing of the arteries that supply the heart, as well as heart rhythm problems, that can occur with cancer treatments.
Host: Wow. How common is this for these two conditions to occur together?
Dr. Desai: So, luckily it's not that common. But we do see in probably something around 20% of the people who've been treated for cancers do develop some issues related to either things that we mentioned earlier, such as heart rhythm issue, potentially damage to the heart muscle or things like high blood pressure or high cholesterol.
Host: So, what are some of the causes of heart disease when you're talking about cancer treatments?
Dr. Desai: When we look at cancer treatments, there classically have been two drugs that have been implicated in causing issues with the heart muscle. One of them is adriamycin. And another one is Herceptin. Herceptin is a drug commonly used for breast cancer therapy. And there's been multiple studies looking at those drugs causing issues with the heart muscle, making it not as strong as it used to be.
We also know that people who receive radiation therapy to their chest for certain types of cancer can develop issues with their heart valves, narrowing of the heart arteries, as well as an inflammation of the sac around the heart called pericarditis.
Host: Wow.
Dr. Desai: As you know, there's more and more novel treatments to cancer care. There's new novel therapeutics that are out there. Immunotherapeutics that treat cancer in different ways. And we're just learning about those new medicines and how they can potentially affect the heart.
Host: I was just going to ask you if there's new research. So, maybe you could get rid of these old treatments that wouldn't damage the heart. Do you think that's a possibility in the future?
Dr. Desai: It's definitely a possibility, but the new drugs that are coming out, they're almost coming out on a daily basis to treat cancer, cause they're so effective at treating cancer with a real reduction in some of the side effects. But some of these drugs, we're just learning about how these drugs also can have potential cardiovascular effects. And there's a lot of groups that are out there, both from the American College of Cardiology, as well as the Oncology Societies that are trying to find out and study these new cancer drugs to make sure that there's not cardiovascular toxicities that come to light with these newer drugs.
Host: That's gotta be so frustrating as a patient to be treating one thing that causes another and of all things, your heart.
Dr. Desai: And I'm sure it's frustrating also for the providers that we think we're doing the best thing by treating them for disease A and they seem to develop a secondary disease related to the treatment that we thought we were doing the right thing about.
Host: Absolutely. So, how long does the increased chance of heart disease continue after the cancer treatments are all finished?
Dr. Desai: Well, when we look at the older drugs, the ones that I talked about previously, sometimes that can be irreversible. There are times where those drugs, once you've stopped using those drugs, the effect goes away and the heart can come back to normal. But there is a dose dependency with some of these drugs that over time that despite stopping the medication that there's been enough of it delivered, the heart muscle can remain weak over time.
Host: So, as a cancer patient or survivor, what symptoms should you be looking for that might indicate a heart condition?
Dr. Desai: So, things that we find can be really tell taling are things such as shortness of breath, meaning that you're having a hard time catching your breath when you exert yourself or even at rest. Things that people can notice such as swelling of their legs going in their ankles, maybe the shoes don't fit, right, cause they've developed, what's called edema or swelling of their legs. And obviously the things that are really scary, such as chest pain and palpitations, those things will obviously bring people to light in terms of a cardiovascular effect of their chemotherapy.
Host: What kind of doctors should cancer patients and survivors see for heart care?
Dr. Desai: Most cardiologists are attuned to the different issues that occur with the cancer drugs. Obviously we're lucky at Upper Chesapeake that we have a cardiac-oncology program, where we in combination with the oncologists and the hematologists see patients. So, we have a center in the oncology building here at Upper Chesapeake, where we see people who are at risk for developing cardiovascular toxicities related to classical therapies. And we, follow them longitudinally. So, over time, over months, over years, doing things like ultrasounds of their heart to see if their heart muscle recovers, to see does their heart muscle deteriorate further with more therapies also just seeing them at a clinical basis. Does their swelling get worse? Do they develop improvement of their symptoms as we adjust their therapies?
There's many of these programs, obviously, probably a dozen years ago, this was really just coming to light. And over the last 10 years, we've seen a real robust understanding of how immunological agents and chemotherapy can affect the heart. There's many of these programs all over the country.
Host: Well, that's encouraging. If somebody has both cancer and heart disease, what can they expect to have to undergo?
Dr. Desai: They usually get the typical cardiovascular and oncology comprehensive care. So, an examination with the physician, a review of their laboratory studies, obviously in the setting of a cardiologist, an EKG and their cholesterol and their normal routine care. Obviously we monitor them much closer, in terms of looking at their heart muscle a little more frequently, anywhere from every three to six months. We probably do EKGs a little more frequentyl than we would looking for heart rhythm problems, to see if these come to light with these new chemotherapeutic agents.
Host: Are there some things that cancer patients can do to prevent heart complications?
Dr. Desai: Well, I think all the things that we tell people to do in terms of just improving their lifestyle. So exercise, watching your salt intake, watching your cholesterol intake, obviously no tobacco use, things that I think we all say are good for your overall health will help when it comes to your cardiovascular health. There are studies that are ongoing looking at different therapeutic trials in terms of medications that could potentially be used in combination with cancer agents to see if we can reduce some of these side effects or affects that we see with cancer drugs.
Host: Dr. Desai, do you have any key takeaway that you would like to share with us?
Dr. Desai: Well, I think that if any person who has cancer or any person who has cardiovascular disease and cancer, I think it's important that they get comprehensive care, whether that's through their regular cardiologist, their regular oncologist, or through a cardiac oncology program that's available to them.
Host: Thank you so much Dr. Desai. This has been so educational and I really appreciate your time.
Dr. Desai: Thank you again for asking me to speak and I really appreciate the time.
Maggie McKay (Host): This episode is sponsored by the university of Maryland cancer network led by the university of Maryland, Marlene and Stewart green balm comprehensive cancer center. One of the nation's NCI designated comprehensive cancer centers. The U M cancer network provides access to national experts. The latest treatments, leading edge technology and promising clinical trials all close to home. The U M cancer network helping you beat cancer once. And for all,
Host: Find more shows like this one at umms.org/podcast. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.
How Can Cancer Affect Your Heart?
Maggie McKay (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach so you have everything you need to live your life to the fullest.
This episode is sponsored by the university of Maryland cancer network
I'm Maggie McKay. My guest today is Dipan Desai, a Cardiologist with Upper Chesapeake Health with a special interest in cardio-oncology. Thank you so much for being here, Doctor.
Dipan Desai, MD (Guest): Thank you for having me. I really appreciate the time.
Host: Absolutely. We're going to discuss how cancer can affect your heart. So, cardiovascular disease and cancer are leading causes of death in the US. Are they linked in any way?
Dr. Desai: So, we've found that many people who have treatment for cancers can develop cardiovascular effects. There's definitely issues with damage to the heart valves, damage to the heart muscle, narrowing of the arteries that supply the heart, as well as heart rhythm problems, that can occur with cancer treatments.
Host: Wow. How common is this for these two conditions to occur together?
Dr. Desai: So, luckily it's not that common. But we do see in probably something around 20% of the people who've been treated for cancers do develop some issues related to either things that we mentioned earlier, such as heart rhythm issue, potentially damage to the heart muscle or things like high blood pressure or high cholesterol.
Host: So, what are some of the causes of heart disease when you're talking about cancer treatments?
Dr. Desai: When we look at cancer treatments, there classically have been two drugs that have been implicated in causing issues with the heart muscle. One of them is adriamycin. And another one is Herceptin. Herceptin is a drug commonly used for breast cancer therapy. And there's been multiple studies looking at those drugs causing issues with the heart muscle, making it not as strong as it used to be.
We also know that people who receive radiation therapy to their chest for certain types of cancer can develop issues with their heart valves, narrowing of the heart arteries, as well as an inflammation of the sac around the heart called pericarditis.
Host: Wow.
Dr. Desai: As you know, there's more and more novel treatments to cancer care. There's new novel therapeutics that are out there. Immunotherapeutics that treat cancer in different ways. And we're just learning about those new medicines and how they can potentially affect the heart.
Host: I was just going to ask you if there's new research. So, maybe you could get rid of these old treatments that wouldn't damage the heart. Do you think that's a possibility in the future?
Dr. Desai: It's definitely a possibility, but the new drugs that are coming out, they're almost coming out on a daily basis to treat cancer, cause they're so effective at treating cancer with a real reduction in some of the side effects. But some of these drugs, we're just learning about how these drugs also can have potential cardiovascular effects. And there's a lot of groups that are out there, both from the American College of Cardiology, as well as the Oncology Societies that are trying to find out and study these new cancer drugs to make sure that there's not cardiovascular toxicities that come to light with these newer drugs.
Host: That's gotta be so frustrating as a patient to be treating one thing that causes another and of all things, your heart.
Dr. Desai: And I'm sure it's frustrating also for the providers that we think we're doing the best thing by treating them for disease A and they seem to develop a secondary disease related to the treatment that we thought we were doing the right thing about.
Host: Absolutely. So, how long does the increased chance of heart disease continue after the cancer treatments are all finished?
Dr. Desai: Well, when we look at the older drugs, the ones that I talked about previously, sometimes that can be irreversible. There are times where those drugs, once you've stopped using those drugs, the effect goes away and the heart can come back to normal. But there is a dose dependency with some of these drugs that over time that despite stopping the medication that there's been enough of it delivered, the heart muscle can remain weak over time.
Host: So, as a cancer patient or survivor, what symptoms should you be looking for that might indicate a heart condition?
Dr. Desai: So, things that we find can be really tell taling are things such as shortness of breath, meaning that you're having a hard time catching your breath when you exert yourself or even at rest. Things that people can notice such as swelling of their legs going in their ankles, maybe the shoes don't fit, right, cause they've developed, what's called edema or swelling of their legs. And obviously the things that are really scary, such as chest pain and palpitations, those things will obviously bring people to light in terms of a cardiovascular effect of their chemotherapy.
Host: What kind of doctors should cancer patients and survivors see for heart care?
Dr. Desai: Most cardiologists are attuned to the different issues that occur with the cancer drugs. Obviously we're lucky at Upper Chesapeake that we have a cardiac-oncology program, where we in combination with the oncologists and the hematologists see patients. So, we have a center in the oncology building here at Upper Chesapeake, where we see people who are at risk for developing cardiovascular toxicities related to classical therapies. And we, follow them longitudinally. So, over time, over months, over years, doing things like ultrasounds of their heart to see if their heart muscle recovers, to see does their heart muscle deteriorate further with more therapies also just seeing them at a clinical basis. Does their swelling get worse? Do they develop improvement of their symptoms as we adjust their therapies?
There's many of these programs, obviously, probably a dozen years ago, this was really just coming to light. And over the last 10 years, we've seen a real robust understanding of how immunological agents and chemotherapy can affect the heart. There's many of these programs all over the country.
Host: Well, that's encouraging. If somebody has both cancer and heart disease, what can they expect to have to undergo?
Dr. Desai: They usually get the typical cardiovascular and oncology comprehensive care. So, an examination with the physician, a review of their laboratory studies, obviously in the setting of a cardiologist, an EKG and their cholesterol and their normal routine care. Obviously we monitor them much closer, in terms of looking at their heart muscle a little more frequently, anywhere from every three to six months. We probably do EKGs a little more frequentyl than we would looking for heart rhythm problems, to see if these come to light with these new chemotherapeutic agents.
Host: Are there some things that cancer patients can do to prevent heart complications?
Dr. Desai: Well, I think all the things that we tell people to do in terms of just improving their lifestyle. So exercise, watching your salt intake, watching your cholesterol intake, obviously no tobacco use, things that I think we all say are good for your overall health will help when it comes to your cardiovascular health. There are studies that are ongoing looking at different therapeutic trials in terms of medications that could potentially be used in combination with cancer agents to see if we can reduce some of these side effects or affects that we see with cancer drugs.
Host: Dr. Desai, do you have any key takeaway that you would like to share with us?
Dr. Desai: Well, I think that if any person who has cancer or any person who has cardiovascular disease and cancer, I think it's important that they get comprehensive care, whether that's through their regular cardiologist, their regular oncologist, or through a cardiac oncology program that's available to them.
Host: Thank you so much Dr. Desai. This has been so educational and I really appreciate your time.
Dr. Desai: Thank you again for asking me to speak and I really appreciate the time.
Maggie McKay (Host): This episode is sponsored by the university of Maryland cancer network led by the university of Maryland, Marlene and Stewart green balm comprehensive cancer center. One of the nation's NCI designated comprehensive cancer centers. The U M cancer network provides access to national experts. The latest treatments, leading edge technology and promising clinical trials all close to home. The U M cancer network helping you beat cancer once. And for all,
Host: Find more shows like this one at umms.org/podcast. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.