Cancer Survivors and Cardiovascular Risk: What Patients Should Know From the Perspective of Another Survivor

I’m a lucky guy, and I know it. In 1984, I was treated for testicular cancer with a then-revolutionary new cocktail of medications known as PVB (the platinum-based drug cisplatin plus vinblastine and bleomycin). One decade earlier, many of those diagnosed with testicular cancer had died, most of them young men between 15 and 35 years of age. This new drug regimen flipped the odds, and after 5 years, I was deemed cured. Hurrah!

I didn’t know there would be a health cost to that cure. One of those “costs” is cardiotoxicity. In other words, the cisplatin¹ that saved my life is associated with a higher risk of cardiotoxicity, which can include myocardial infarction, coronary artery disease, heart failure, valve disease, and arrhythmias. Some of the other cancer treatment drugs, now understood to do the same, include, but are not limited to, anthracyclines, used to treat leukemia, lymphoma, breast cancer, sarcoma, and multiple myeloma; trastuzumab used to treat breast cancer, gastric cancer, and cancer of the gastroesophageal junction; and carboplatin, which is used to treat ovarian, bladder, head and neck, lung, and cervical cancer and sometimes testicular cancer. Cardiotoxicity is also insidious because it can take a long time to manifest.

Brant Inman, a surgeon who focuses on bladder, kidney, and testicular cancers at the Schulich School of Medicine & Dentistry, Western University, Ontario, Canada, and formerly at the Duke Cancer Center, explained to me, “We’re increasingly noticing, especially in younger patients who have many years of life left if cured, who experience complications of the medical treatments we gave to [treat] them.” Cancer patients make a Faustian bargain without the knowledge of what’s being traded away.

Anne Blaes, a professor of hematology and oncology at the University of Minnesota who focuses on the later-in-life effects of cancer treatment, told me that heart complications can develop years, if not decades, after cancer treatment, posing special risks for people like me who are 50+. “It’s more than just age at time of the cancer, though—it’s the kind of cancer, and how it’s treated,” she said.

As new cancer treatments continue to be developed, we may be planting the seeds of new long-term effects, she said. “Among the many new therapies, there’s a growing concern about [the after effects of] immunotherapy and what this does to atherosclerosis,²” or thickening or hardening of the arteries, Blaes said. “We simply don’t know yet.”

Who Is Most at Risk for Heart Disease After Cancer?

The cardiovascular risk calculator³ produced by the Childhood Cancer Survivor Study predicts the risk of several heart issues by age 50 among survivors of childhood cancer. In general, the most at-risk cancer survivors include 1) individuals 60 years of age and over, young children, and women and 2) people who were treated with high doses of anthracyclines, high-dose radiation to the chest, or both, and have a history of smoking, high blood pressure, diabetes, obesity, or other heart problems.

What Can You Do to Reduce Risk of Post-Chemotherapy Heart Trouble?

Oncologists recommend developing an individual plan tailored specifically for your circumstances. For instance,

• •If you don’t know, find out what drugs you received. If you had radiation, which parts of your body were treated? If you don’t see an oncologist anymore, many cancer treatment clinics have survivorship programs that will get your records and create a care plan, or for a personal plan tailored just for you. Check out Oncolink,⁴ for no charge, although you must know your previous treatment history to use it.
• •Make sure all your doctors know your medical history and risk factors, which include blood pressure, glucose and cholesterol levels, chronic inflammation, viral exposure, tobacco use, obesity, and physical activity. I was surprised when Anne Blaes explained that cardiovascular risk was substantially higher if you had high blood pressure and had had certain chemotherapy regimens compared to those without high blood pressure with the same drug exposures. Blaes fears that many primary care doctors will see a blood pressure reading of 140 over 90 and say, “It’s fine.” It may not be fine. Not when you’ve had these drugs before.
• •For those seeking more detailed and customized information about specific cancer treatments and heart disease, the American College of Cardiology’s CardioSmart tool is another resource.

Not to be overlooked are the growing number of cancer survivorship programs, which the Mayo Clinic says “help cancer survivors live well after cancer treatment. A cancer survivorship clinic may help you manage physical and emotional changes you may experience after your cancer treatment.” To learn more about resources for cancer survivors and their caregivers, the National Cancer Institute’s website⁵ has additional information.

Included among the services offered at most of these programs are the following:

• •Reviewing your cancer diagnosis and treatment
• •Helping you understand your cancer diagnosis and treatments as well as the long-term complications you may face
• •Conducting examinations to assess your physical and emotional needs
• •Identifying and creating management strategies to help you cope with physical, emotional, and social effects of your cancer and your cancer treatment
• •Assessing your risk of cancer recurrence or other types of cancers based on the latest surveillance guidelines and, as needed, providing referrals to cancer screening services and follow-up care
• •Recommending ways to improve your health through nutrition, exercise, weight management, and quitting smoking
• •Creating a personalized follow-up care program for you and your doctors
• •Consulting with the doctors who diagnosed and treated your cancer, as needed
• •Providing referrals for wholistic care experts including, but not limited to, dietitians, physical therapists, and integrative medicine specialists

If I am lucky, so too is Susan Gambucci, a 59-year-old retired teacher who was diagnosed with non-Hodgkin lymphoma in 1982 at age 17. As a teen, she was treated with 4 rounds of chemotherapy and radiation to the chest. Her doctor explained that she’d have fertility issues and that one day, “in the way, way future,” she might need a heart valve replacement.

“They asked me, ‘Do you want to take the risk?’ Yeah, I do! I’m a junior in high school, facing imminent death.”

Three decades later, Gambucci needed her aortic valve replaced followed by a triple bypass. Both her mitral and tricuspid heart valves now leak severely, causing shortness of breath, fatigue, lightheadedness, and a rapid fluttering heartbeat. A more comprehensive work-up not long ago revealed she needed a heart transplant, although she’s considered too high risk a patient to qualify for one.

She told me her oncologist believes the chemotherapy and radiation she received as a teen are likely the cause of her heart issues. When I spoke with Susan earlier this year, she told me she knows that her heart disease is only going to get worse. Still, she noted that a doctor at the Mayo Clinic told her, “You’re lucky to have these problems,” meaning she’s lucky to be alive.

Gambucci then asked me, “Do you understand what I’m saying?” “Yes, I do,” I told her. Meaning yes, I too know how lucky I am and that nothing comes without a price.

About the Author

Steven Petrow is a contributing columnist to The Washington Post and the author of 7 books, including Stupid Things I Won’t Do When I Get Old and The Joy You Make. For more than 2 decades, he’s been a volunteer at the Memorial Sloan Kettering Cancer Center, and he dedicates this essay to his sister Julie, who died in 2023 from complications from ovarian cancer. Parts of this essay originally appeared in The Washington Post.

Funding Support and Author Disclosures

The author has reported that he has no relationships relevant to the contents of this paper to disclose.