Dr Tochi Okwuosa Discusses Heart Health Consequences From Cancer Treatment

Tochi M. Okwuosa, DO, Rush University Medical Center, discusses ways in which cancer treatments can adversely affect heart health outcomes for patients under the care of oncologists.

Tochi M. Okwuosa, DO, cardiologist and director of cardio-oncology at Rush University Medical Center in Chicago, discusses how physical health and treatment for cancer interact, often resulting in adverse heart health outcomes for patients under the care of oncologists.


What risk factors predispose cancer survivors to a higher risk of cardiac disease/damage?

Certain sorts of the typical cardiovascular risk factors, their comorbid conditions, if they have lung disease, kidney disease—all of that affects the patient. The kinds of cancer treatments that particularly affect the patient, the prototypical one is anthracyclines. Those are the sorts of treatments that are used for breast cancer, for lymphoma, for some of the leukemias; some of the GI [gastrointestinal] cancers use them. Anthracyclines are the particular ones that are known to cause heart failure and cardiac toxicity. But there's a whole lot of other ones.

Trastuzumab, or Herceptin, type of treatments, anti-HER2 [human epidermal growth factor receptor 2] therapy that are used for treatment of breast cancer. Then there's tyrosine kinase inhibitors that are used for practically all the different kinds of cancers, in one shape or form, that have cardiovascular consequences like heart failure and hypertension and so on. There's Bruton kinase inhibitors like ibrutinib and acalabrutinib, that increase the risk of arrhythmias. There is 5-FU, or 5-fluorouracil, and capecitabine, that increase the risk of coronary spasms and heart attacks as a result.

There's radiation therapy that increases the risk of valvular heart disease, coronary artery disease, arrhythmias, pericardial diseases. And then there's more recent, more modern-day therapies like immunotherapies that can increase the risk of myocarditis, or inflammation of the heart muscle, and there is the CAR [chimeric antigen receptor] T-cell therapy, which is also a type of immunotherapy, that can cause what we call CRS, or cytokine release syndrome, that can have consequences on the heart and cause cardiovascular collapse and hypotension, which can lead to death. And stem cell transplant, which has long-term consequences, because it's not just the chemotherapy that they receive prior to stem cell and during stem cell, it's also a function of the immunosuppressive therapy that some of them have to be on for a long time that can affect the heart.

Practically all the different forms of cancer have some sort of therapy or therapies that have cardiovascular consequences that we have to think about. And that's on top of the comorbid conditions and the cardiovascular risk factors and the social determinants of health and all these other things that can influence outcomes in patients.

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