Keeping the Heart Healthy While Beating Breast Cancer
Today, thanks to treatment advancements, the majority of women diagnosed with breast cancer can expect to be cured. But what if focusing on beating the cancer means weakening what beats in her chest?
Two Duke researchers are now looking beyond cancer therapy to potentially save more lives by focusing on heart health.
By bringing together oncologists and primary care providers, Kevin Oeffinger, MD, director of the Duke Cancer Institute (DCI) Center for Onco-Primary Care, and Susan Dent, MD, co-director of the Duke Cardio-Oncology program, are examining the long-term impact that cancer therapies can have on a woman’s heart health.
With a roughly 88 percent cure rate for breast cancer, Oeffinger says, it’s more important than ever to concentrate on the detrimental side effects that can accompany life-saving treatments.
“We focus so much on the cancer that sometimes we forget to pay closer attention to blood pressure, cholesterol, and diabetes, allowing those conditions to be less than optimally managed,” he says. “Over time, we’ve learned that women who’ve undergone oncology treatments are more likely to die of a heart attack or stroke than they are breast cancer. And, it’s not because of the things we do. It’s because of the things we don’t do.”
Oeffinger and Dent are involved in two clinical trials—one examining blood pressure during cancer treatments and the other investigating whether breast cancer treatments (including chemotherapy and/or radiation) can induce other health problems after cancer therapy ends.
Both studies aim to forge and strengthen collaborations between oncologists, cardiologists, and primary care providers.
High-tech, At-home Hypertension Monitoring
During cancer treatments, hypertension is often overlooked, Dent says, and left uncontrolled, it remains the biggest predictor of long-term cardiovascular morbidity and mortality.
Consequently, healthcare providers need a better way to track and share information about this crucial indicator.
In a Duke Institute for Health Innovation-supported, first-of-its-kind pilot study, Oeffinger plans to enroll 10 women actively receiving breast cancer treatment, as well as 10 prostate cancer, lymphoma, and post-bone marrow transplant patients each. Patients will use a Bluetooth blood pressure monitor to measure their levels at home.
Not only does the system remind patients to take three measurements weekly, but it also connects to a smartphone app, immediately recording and transmitting readings to the patient’s electronic health record, as well as sending providers messages if readings are too high.
“This system does what primary care providers and oncologists say they need,” Oeffinger says. “The primary provider needs to know when to intervene and what strategies to pursue that don’t conflict with the patient’s chemotherapy. And, the oncologist needs a simple way to partner directly and routinely with the primary provider.”
The goal, he says, is to identify when cancer therapies increase blood pressure, potentially pinpointing any increased risk of heart attack or stroke within the subsequent 10 years. Additional financial support for the study could open enrollment to more patients.
Analyzing Oncology's Impact
Dent is leading the Duke site of a National Cancer Institute-funded, multi-center study, called UPBEAT, that is intended to examine the long-term impacts of chemotherapy and radiation on the cardiovascular health of women treated for early-stage breast cancer. Similar work has studied the impact of cancer treatments on cardiovascular health in pediatric cancer survivors, but little adult-focused research exists, she says. The study will recruit 1,000 women nationally, including 160 women without breast cancer, but additional funding is needed to cover the cost of recruiting patients at Duke.
“This study is very important because it will help define which women are at increased risk of developing cardiac problems related to their breast cancer treatment,” Dent says. “And, if we know, we can think of preventive strategies to attenuate or diminish the risk of long-term cardiovascular effects.”
By following the participants for several years and collecting data on their medications, cardiovascular risk factors, other health conditions, physical activity, and neurocognitive health, researchers hope to determine the long-term consequences of standard therapies on heart function, exercise ability, neurocognitive function, and fatigue.
For example, some cancer treatments increase the risk of developing heart failure, and radiation treatment can increase the risk of developing coronary artery disease years after cancer therapy.
Additionally, previous research conducted at Duke revealed that cancer treatments can have a negative impact on an individual’s exercise capacity: after receiving breast cancer treatment, a 50-year-old woman can have a fitness level equivalent to a sedentary 70-year-old woman.
Being able to decrease the impact of cancer therapy on an individual’s fitness level will greatly improve patients’ overall health.
To date, it has been difficult for oncologists to know how their prescribed treatments affect patients years after completion of their cancer therapy, Dent says, because oncologists rarely stay in contact once patients are discharged back to their primary care providers.
“Ten to 15 years after surviving cancer, a patient can end up on the cardiology ward in heart failure potentially related to our treatments,” she says. “That’s why it’s important for us to collaborate and look holistically at our patients to determine the best cancer-care strategies that won’t potentially compromise their cardiovascular health.”