Caring for Your Heart

I used to subscribe to the Journal of the American Medical Association, and I still have access to some of the content from JAMA and  some of its specialty journals (like JAMA Oncology). 

The JAMA Oncology journal has something called the "Patient Page," with interesting information aimed at patients with cancer. I'm not sure how many patients actually see these pages, since they appear in the medical journal. Maybe there are oncologists who share the information with patients? I have no idea.

Which is too bad, because the information can be useful.

The most recent Patient Page, for example, is called "Caring for Your Heart During Cancer Treatment."

It's valuable information, getting at what cardio-oncology is -- a cardiologist to look after your heart along with the oncologist looking after your cancer. And it lists some of the heart problems that can happen while receiving cancer treatment.  Some of those problems include:

Cardiomyopathy (damage to the heart muscle)

Arrhythmias (heart beating too fast or too slow or too irregularly)

Pericardial disease (problems with the pericardium, which covers the heart)

Hypertension (high blood pressure)

Thromboembolic events (blood clots)

Myocardial ischemia (reduced blood flow to the heart)

Valvular dysfunction (problems with the valves that control blood flowing through the heart)

Vascular toxic effects (damage to blood vessels).

 Not every cancer treatment results in cardiac problems. For example, some of the elements of CHOP can cause heart issues (which is why you can only receive it once, and so many oncologists will reserve it for aggressive or transformed lymphoma). 

The Patient Page also gives some advice for how to take care of your heart before you receive treatment. Controlling high blood pressure and high cholesterol, for example, before treatment can help lower the risk of heart problems that the treatment could bring on.

I think that's a weakness of this Patient Page, though. How many of us think about controlling heart problems on the off chance that we get cancer some day?

Of course, for those of us in the Follicular Lymphoma community, that's a little different. Some us watch and wait before we get treatment, and that can give us an opportunity to improve our health (our hearts and our overall health) before we need treatment. Similarly, for those of us who might need a second or third treatment after some time, that interval also gives us the chance to improve our health. (Assuming the treatment has allowed us the ability to do those things.)

One other weakness of this Patient Page - it doesn't talk about long-term side effects that come with cancer treatment. Many patients end up with heart-related issues sometime after the treatment has been finished. As I have been saying lately, that's a survivorship issue. When the treatment is "finished," some patients feel like they have been abandoned. I would have liked to have seen at least a mention of that issue. Even if we aren't in active treatment, heart problems can come up. It's something we should all be aware of and look out for.

The larger issue here is that heart-related problems need to be paid attention to -- before, during, and after cancer treatment.

This is a good time to remind you that I am not an oncologist or a cancer researcher. I'm just a patient who reads a lot.

That means that most importantly, this is an issue that you should discuss with your oncologist, not matter where you are on that treatment time line (before, during, or after).  If a cardio-oncology team seems appropriate, it should maybe be put in lace as soon as possible after diagnosis. But at the very least, when it comes time to have discussions with your doctor about possible treatments, there needs to be a discussion about the short-term and long-term physical side effects of the treatments your doctor is recommending.

All of this is just another reminder for me of how much cancer affects our lives, even before treatment.

Take care of yourselves.