Cardio-oncology

Cardio-oncology is the field of medicine dedicated to protecting the hearts of cancer patients before, during and after cancer therapy. It includes the prevention of heart disease before therapy has even started through detail risk prediction, careful heart surveillance during cancer treatment and the long-term health of cancer survivors. 

Royal Brompton Hospital is recognised as a Gold Class Centre of Excellence by the International Cardio-Oncology Society. We set up the first dedicated cardio-oncology service in the UK and have since provided heart care to over 2,000 cancer patients and survivors.  

What is cardiotoxicity?

Cancer treatments like chemotherapy and radiotherapy can help patients live longer. However, these treatments can also have side effects, including heart damage, known as cardiotoxicity.

What cancer treatments can lead to cardiotoxicity?

• Chemotherapy: specific chemotherapy drugs, such as anthracyclines, have a higher risk of causing heart damage. The risk may also increase if you are taking multiple chemotherapy drugs.  
• Targeted cancer treatments:  although these drugs are more specific for certain cancers, such as Herceptin for breast cancer, they can lead to complications such as myocarditis (inflammation of the heart muscle). This risk is increased if targeted treatments are combined with chemotherapy drugs like anthracycline.  
• Immunotherapy: this relatively new cancer treatment works by helping the immune system recognise and attack cancer cells, and includes a class of drug called immune checkpoint inhibitors. There is a risk that immunotherapy can lead to inflammation in parts of the body, including the heart.  
• Radiotherapy: this treatment uses radiation to kill and shrink cancers, but it can also result in damage to organs and tissues surrounding the cancer it is targeting. This can result in heart damage if radiotherapy is given to the chest.

Who is at higher risk of cardiotoxicity?

Anyone who receives cancer treatment may experience cardiotoxicity from the treatment itself. However, there are some risk factors that make it more likely.  

The risk of cardiotoxicity is higher in those with pre-existing medical conditions affecting the heart, including high blood pressure, coronary artery disease, arrhythmia (irregular heart rhythm) and valvular heart disease.  

Cardiotoxicity is also more common in adults who have had cancer treatment as a child. People older than 60 are also at an increased risk, even if they have not previously had cancer treatment.

What are the types of cardiotoxicity?

Cardiotoxicity can result in different heart problems, including:  

• arrhythmia (abnormal heart rhythm) 
• cardiomyopathy (damage to the heart muscle) 
• coronary heart disease 
• heart attacks 
• heart valve disease  
• hypertension (high blood pressure) 
• pericardial disease (inflammation of the sac surrounding the heart)

What are the symptoms of cardiotoxicity?

The symptoms of cardiotoxicity relate to the specific heart damage caused by cancer treatments. They can include:  

• chest pain  
• dizziness 
• heart palpitations 
• shortness of breath  
• swelling and fluid retention in the legs (called oedema) 

If you experience any of these symptoms during cancer treatment, you should speak to your doctor as soon as possible.  

How is cardiotoxicity diagnosed?

Our cardiology specialists may refer you for different heart tests to understand if it has been damaged from cancer treatments. As your symptoms may be due to something else, this is the best approach to understanding how best to help.  

Heart tests may include:  

• electrocardiogram (ECG): this test looks at electrical activity of the heart to better understand if there are problems with your heart rhythm 
• echocardiogram: this is a type of ultrasound scan that looks for defects in the heart chambers and valves 
• cardiac MRI: this is a non-invasive test that uses strong magnets and radio waves to take detailed images of your heart’s structures to understand how blood is flowing through it 
• CT scan: this is an imaging test that uses low-dose X-rays to produce detailed images of the heart. It may be used to determine cardiotoxicity after radiotherapy targeting cancer in the chest

How is cardiotoxicity treated?

Our cardio-oncology specialists work to support your cancer treatment, not prevent it.  

Depending on your symptoms, they may recommend adjusting the dose of your cancer treatment or for an alternative to be explored. They may also prescribe new heart medications or change the dose of existing ones to help your heart work more efficiently.   

Some of the heart medications you could be prescribed include: 

• ACE inhibitors, which work to dilate (open up) your arteries and improved blood flow 
• beta blockers, which slow your heart rate and improve blood flow  
• digoxin, to help your heart beat more efficiently  
• diuretics, to help your body get rid of excess fluid  
• vasodilators, to dilate your blood vessels and help it move around your body more efficiently

When should I see a cardio-oncology specialist?

Before your cancer treatment starts

The best time to see one of our cardio-oncology specialists is before cancer treatment is started. We can review your overall heart health and risk factors that may make the chance of developing problems more likely with certain cancer treatments.  

We can provide a personalised plan to initiate treatments that can protect your heart health before you start your cancer treatment.  

During your cancer treatment

We can help monitor your heart health throughout cancer treatment to spot the earliest signs of cardiotoxicity. We can make recommendations to change the dose of your cancer treatment and prescribe additional treatments that manage heart problems that may arise (such as an irregular heart rhythm). 

After your cancer treatment ends

Some heart problems appear during cancer treatment, but some may not appear for 10 or more years after it has ended. Our cardio-oncology specialists can determine whether any damage may have been caused with cancer treatment and provide the best treatment to manage it.