Carolyn Reilly, PhD, RN, CHFN, FAHA
Katherine Yeager, PhD, RN
Carolyn Reilly is an assistant professor and Kate Yeager is an assistant professor at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, Georgia.
The American Cancer Society estimates that almost 14.5 million cancer survivors are alive in the United States today. By 2024, the number of survivors will grow to almost 19 million. Many factors contribute to this growing number, including earlier diagnosis, improved treatments, and better follow-up care.
But are cancer survivors getting the specific care they need?
The Institute of Medicine’s report From Cancer Patient to Cancer Survivor: Lost in Transition1
recognizes that the current US healthcare system does not often deliver the comprehensive and coordinated follow-up care that cancer survivors require. The reports calls on providers not only to arrange for surveillance for cancer recurrence but also offer holistic care addressing chronic effects of cancer and treatment side effects, monitoring for and preventing late effects like heart disease, and promoting a healthy lifestyle.
Cardiotoxicity and Cancer
Because nursing has a significant role on the “front lines” of cancer care both in hospitals and ambulatory settings, nurses must serve as a source of knowledge and advocacy for cancer survivors. One specific area that requires attention and research is cardiac health in cancer survivors.
Cancer survivors have nearly an 8-fold increased risk of death due to cardiovascular disease compared with the general population. Potential mechanisms include the cardiotoxic effects of chemotherapy and radiation, and modifiable risk factors related to cardiac health including inactivity, poor diet composition, and excess weight. In addition, cancer survivors experience disease- or treatment-related symptoms that persist post-therapy which are often barriers to an active lifestyle.
Both radiation and chemotherapy can result in cardiotoxicity. Pericardial effusion, pericardial constriction, myocardial dysfunction, and heart failure may be serious clinical conditions encountered among cancer survivors. Effects of chest radiotherapy are manifested as coronary artery disease and valvular dysfunction.
Chest irradiation can also contribute to cardiac dysfunction after the myocardium gets exposed to certain dose levels of radiation. Specific to chemotherapy, anthracyclines (such as doxorubin, epirubicin, liposomal doxorubicin, or mitoxantrone) are major contributors of cardiomyopathy. Unfortunately, these cardiotoxic side effects from treatments are often exacerbated by coexisting conditions like hyperlipidemia and hypertension.
Carolyn Reilly, an assistant professor at the Nell Hodgson Woodruff School of Nursing at Emory University, recently completed a study to describe the prevalence of cardiovascular disease in lymphoma survivors.2
Participants (N = 31) in this cross-sectional, correlational study were a mean age of 47.6 years; most were males (55%) and white (84%). Participants averaged 5 years since lymphoma treatment. Routine laboratory tests and fasting lipid levels, coronary artery calcification computed tomography, echocardiography, and patient-reported outcomes were measured.