While new blood cancer treatments are providing more options and expanding the lives of patients with hematologic malignancies, they can also lead to cardiac toxicities – both during active treatment and into survivorship. So, clinicians must be careful in choosing the best regimen for a patient, and closely monitor them for any heart problems.
“[Cardiac issues] could absolutely affect your treatment option choices. Patients who have pre-existing coronary disease may not be good candidates for anesthesia, surgery, or certain agents,” said Brenda Shelton, DNP, APRN-CNS, CCRN, AOCN, of the Sidney Kimmel Cancer Center at Johns Hopkins University.
Shelton presented on cardiac toxicities at the NCCN 2020 Virtual Congress on Hematologic Malignancies Nursing Forum.
Patients With Increased Risk of Heart Complications
“You may have patients with coronary artery disease and lymphoma in the left chest, and that makes them at higher risk for cardiac toxicities. So, the regimen may be altered to omit anthracyclines,” she said.
Shelton outlined other examples of patients who may need to have their blood cancer regimen altered. They included:
- Patients with HIV-related Kaposi sarcoma may not be able to receive the typical dosage doxorubicin if they have a cardiac history
- Patients with pre-existing hypertension may need to alter the dose or steer clear of multi-kinase inhibitors, which can cause hypertension and exacerbate the adverse event
- Patients with low ejection fraction may need central venous pressure monitoring, as well as additional care, including more frequent echocardiograms
- Younger patients, who should have late- and long-term cardiotoxic effects of treatments considered before a treatment plan is chosen
“Patients with hypertension, coronary artery disease, existing heart failure, amyloidosis, or aortic valve disease should all be considered at risk,” Shelton said. “Anyone over the age of 60 years, anyone with a sedentary lifestyle or a high BMI, people that have diet and lifestyle risk factors such as a high-fat diet, high lipids, tobacco and alcohol use [are also at risk].”
Cardiac Diagnostic Tests
There are multiple tests that health care providers can use to diagnose cardiac issues, and it is key to understand what to use and when, Shelton explained.
For example, a brain natriuretic peptide serum level test will allow for early screening for heart failure and can tell clinicians whether or not a heart failure treatment is working. A cardiac MRI can detect tumors or other foreign masses, but when looking for valve, global wall motion, or pericardial fluid abnormalities, an echocardiogram should be used.
An ECG can detect ischemia, injury, an old infarction, electrolyte disorders, or pericardial effusion, and a MUGA scan can show if there is significant compromise of coronary blood flood, and also monitor the progression of coronary artery disease.
“The incidence of cardiac toxicities are significant, and can therefore impact [patients’] quality of life,” Shelton said.