Longevity
Cancer treatment can damage the heart silently, decades after it ends
By Life and Health Today Staff, . Life and Health Today.
Heart damage caused by cancer treatment does not always show up while a patient is still in oncology care. According to Francisco Sebastián Palacid, a nuclear medicine physician at the University Clinical Hospital of Valladolid and coordinator of the Cardiology Working Group at the Spanish Society of Nuclear Medicine and Molecular Imaging, cardiotoxicity, meaning injury to the heart muscle caused by treatment, can surface a decade or two after chemotherapy or radiation has ended. Medscape reported his comments in advance of World Heart Day on September 29.
The patients at highest risk, Palacid told Medscape, are those who received anthracyclines (a class of chemotherapy drugs that includes drugs used widely in breast cancer and lymphoma treatment), the targeted therapy trastuzumab, or radiation directed at the chest. Women treated for breast cancer with anthracyclines combined with trastuzumab carry particularly high cardiac risk, as do lymphoma patients who received both anthracyclines and chest radiation. Children and adolescents treated for leukemia or sarcoma are the most vulnerable group of all, because their hearts are still developing when they receive high doses of chemotherapy. "That is why these patients should be monitored for decades," Palacid said, as quoted by Medscape.
The warning signs he described are easy to dismiss as ordinary ageing: fatigue during activities that used to feel effortless, breathlessness on stairs or when lying flat, swollen ankles, new palpitations, or unexplained weight gain over a few days, which can signal fluid retention. In someone who received cardiotoxic treatment, even ten or fifteen years ago, any of those symptoms warrants attention, he said.
Palacid's central argument, as reported by Medscape, is that primary care physicians carry more of this responsibility than they may realise. Once a cancer survivor stops attending hospital follow-up appointments, the family doctor is often the only clinician who sees them regularly. "Just because a patient is 'cured' of cancer doesn't mean we can forget about their heart," he said, as quoted by Medscape. "Often, the first person to detect a problem is not us or the oncologist, but the family doctor."
How often monitoring should happen depends on cumulative risk. For someone who received low doses with no compounding factors, Palacid described a checkup every three to five years as generally adequate. For patients who received high doses, combined cardiotoxic treatments, chest radiation, or who were treated as children, he described annual or at most biennial monitoring, using an echocardiogram (an ultrasound of the heart) or, where available, a radionuclide scan, as the appropriate standard.
One of the imaging tools he highlighted is radionuclide ventriculography, also called multigated acquisition scanning, a nuclear medicine technique that tracks how well the heart's main pumping chamber is working. Its value, Palacid explained to Medscape, lies in the consistency of its measurements across time, allowing clinicians to track changes in heart function throughout and after chemotherapy.
Access to that technology is uneven. The Spanish Society of Nuclear Medicine and Molecular Imaging has warned, according to Medscape, of significant disparities across Spain's regions and even between hospitals in the same region. Palacid described the problem as concentrated in medium-sized hospitals: not large referral centres with full resources, but not small rural facilities either. When a specialist trained in nuclear cardiology leaves one of those hospitals, the position is often filled by someone without equivalent training, and the technique quietly disappears, he said.
The piece is based on a single specialist's clinical perspective, reported by Medscape, rather than on a new clinical trial or systematic review. What it does not establish is how many cancer survivors are currently missing appropriate cardiac monitoring, or whether closing that gap would reduce rates of heart failure at a population level. Those are questions that would require prospective studies tracking outcomes across large groups of survivors over time. What the available evidence does support, according to Palacid's account as reported by Medscape, is that the risk window is far longer than most patients or their family doctors assume, and that the symptoms, when they arrive, can look like nothing more than getting older.
Anyone who has received chemotherapy or chest radiation and has questions about cardiac monitoring should raise them with a clinician who knows their treatment history.
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