Heart damage from cancer care being treated at LI centers

Cancer treatments can cause collateral damage to the heart say Long Island doctors who are rapidly beginning — and expanding — new centers to address a medical problem that for decades has persisted under the public’s radar.

While certain aftereffects of cancer treatment are well known, such as constant ear ringing or the memory deficits referred to as chemo brain, the damaging effects on the heart have become a growing concern, doctors say.

Specialists across Long Island are racing to raise awareness while mitigating the problem.

“We are starting a cardio-oncology registry of patients who are just beginning chemotherapy,” said Dr. Haoyi Zheng of St. Francis Hospital in Roslyn, who will head a new cardio-oncology program at the hospital’s cancer center.

The registry will allow him and his colleagues to track patients and to treat, and possibly reverse, heart disorders before they become life-threatening.

Zheng’s program is one of several on Long Island in the newly emerging field of cardio-oncology. While doctors are gaining the upper hand in targeting tumors, they are increasingly mindful of the side effects cancer treatments can have on the heart.

On Long Island and beyond, cancer patients have developed heart failure, a chronic condition in which the organ does not pump blood efficiently; cardiomyopathy, another chronic condition in which the heart is abnormally enlarged and its walls stiff; coronary artery disease; heart valve damage, and hypertension, which can lead to heart attack and stroke.

Agents known to be toxic to the heart include the anthracycline drugs used in standard chemotherapy as well as the advanced biologic drugs, known as targeted therapies, that zero in on a single mechanism in tumors that drive growth. Even the newer immunologic therapies, Zheng said, such as those aimed at melanoma and lung cancer can be toxic.

Radiation increases the risk of valve disease in some patients, he said.

“This is a very young science,” said Dr. Lea Baer, co-founder of the cardio-oncology program at Stony Brook University Hospital.

Baer said she is adamant about one thing: Cancer patients should not fear treatment because of potential heart disorders — doctors are working on methods of prevention and early detection.

At the Katz Institute for Women’s Health in New Hyde Park, Dr. Sonia Henry concurred that the specialty is an evolving one, but patients have therapeutic options.

“There are certain medications that are cardio-protective,” said Henry, a cardiologist and specialist in cardio-oncology at the institute, a division of the Northwell Health system. Her center’s cardio-oncology program began two years ago.

Doctors say it is difficult to estimate how many patients develop heart problems as a direct result of chemotherapy or radiation because heart disorders linked to cancer treatment may take years, even decades, to emerge.

“We think the population has been grossly underestimated,” said Dr. Michelle Bloom, a cardiologist and specialist in cardio-oncology with Baer at Stony Brook, referring to studies on the subject.

She said medications known to produce ill-effects on the heart include Herceptin, a targeted breast cancer drug that homes in on the HER-2 protein, a type of signal-receiving receptor. The drug is important because it blocks the cancer-driving messages received by the HER-2 protein.

Some studies have indicated a risk of heart problems for those on Herceptin within a broad range — 5 percent to 30 percent. Evidence of heart problems may be mild, such as shortness of breath, but full-blown heart failure also has been diagnosed.

Bloom said she’s so passionate about cardio-oncology that, as the mother of three children, she considers this new medical specialty, her “fourth child.”

She and Baer aim is to pre-empt heart disease — stop it before it starts.

Dr. Steven Savona an attending physician at the Monter Cancer Center, a division of the Northwell Health system, said his institution is embarking on major prevention studies.

“This is an important issue that we have to address as a society,” Savona said of heart disease caused by cancer treatment.

His center currently is enrolling patients in a trial in which cancer patients will receive a statin drug, which beyond its cholesterol lowering capacities, is known to also quell free radicals, the rogue forms of heart damaging-oxygen molecules to emerge as a consequence of chemotherapy.