Newswise — Despite the known toxic effects of chemotherapy on the heart, the majority of women undergoing breast cancer treatment are not getting the recommended follow-up heart scans, according to research presented at the British Cardiovascular Society (BCS) Conference in Manchester today (1). The research was carried out at the University of Dundee and funded by the Grant Simpson Trust and the Tayside Oncology Research Endowment Fund.

Developments in chemotherapy mean 87 per cent of people survive breast cancer for five years or more (2). Unfortunately many of these people later suffer adverse effects on the heart caused by the treatment. Because of this current breast cancer treatment guidelines recommend the patient’s heart function is assessed before, during and after chemotherapy.

The researchers analysed medical records from the CHEMOCARE database focusing on the 1229 breast cancer patients who were treated with either anthracyclines alone or combined with the monoclonal antibody trastuzumab at Ninewells Hospital, Dundee between January 2003 and December 2014.

Despite clear guidelines that women receiving these treatments should have their heart function monitored (3), only 625 (51 per cent) of the women underwent an echocardiogram to check that their heart function was normal before starting chemotherapy. Of these, only 238 (38 per cent of those screened) had follow-up scans during the course of their treatment, as recommended by the guidelines. Although the researchers expect their findings to be representative of cancer treatment across Scotland and the wider UK, a broader analysis is needed to confirm this.

Chemotherapy can weaken the heart making it less able to pump blood around the body properly. This can ultimately lead to heart failure, which is a serious chronic condition that can be debilitating and, ultimately, fatal. Over half a million people in the UK are living with heart failure but the majority of these cases are caused by damage to the heart after a heart attack (4). More research is needed to determine just how common heart failure is following chemotherapy and to determine why it happens.

Dr Jagdeep Singh, Clinical Research Fellow and Honorary Cardiology Registrar at the University of Dundee and Ninewells Hospital, said:

“We’ve been seeing an increasing number of patients in the heart failure clinic following chemotherapy. This triggered our interest in finding out why and we wanted to see the scale of this problem. We were able to start doing this and evaluate treatment practices by accessing and analysing anonymous medical records.

“Improvements in chemotherapy mean we’ve been able to transform breast cancer from an often fatal condition into a very treatable disease. But, due to the real risk of heart failure, our findings show that doctors need to be more vigilant and institute protective heart treatments earlier.”

Professor Peter Weissberg, Medical Director at the British Heart Foundation (BHF), said:

“Thanks to research, more women are surviving breast cancer than ever before but it is very worrying that some of them go on to develop life threatening heart disease as a consequence of their chemotherapy. This research suggests that oncologists and cardiologists should work together from the outset to minimise the detrimental effects of chemo on the heart, while ensuring the best chance of survival from the cancer.

“Cardio-oncology is a new specialty which has only come about because of improved cancer survival and we hope to see greater cooperation between heart doctors and cancer doctors in the future. The BHF is currently funding research into how some chemotherapy drugs cause the heart muscle to weaken, in the hope that future breast cancer patients’ hearts can be protected.

“If you’re undergoing cancer treatment and are concerned about its effects on your heart, please visit the BHF website to find an information booklet that the BHF produced with Macmillan Cancer Support on this topic.”

Elizabeth Kidd, aged 69 from Brechin in Scotland, underwent chemotherapy for breast cancer around Christmas in 2000. At the time she was warned that the treatment could cause some heart problems but it was not until 2005 when she first started getting symptoms.

In 2008 Elizabeth was diagnosed with atrial fibrillation and heart failure, which means she now has to take up to 8 different medications a day for those conditions alone. Although her heart failure is being managed well, her condition can leave her too breathless to walk uphill to her local shop.

Elizabeth said: “I didn’t think about my heart and that something could go wrong with it. At first I thought my breathlessness was down to my fitness so it was a real shock to learn I had heart problems.

“When I was diagnosed with breast cancer the odds of beating it weren’t as good as they are now so I’m grateful that the treatment I received has helped me beat it. I try to stay positive about my heart problems. My hope is that more research into this will mean women like me who beat breast cancer won’t go on to develop heart failure.”

Find out more about the British Cardiovascular Society Conference at bcs.com/conference.

ENDS

To request interviews or for more information please call the BHF press office on 020 7554 0164 or 07764 290 381 (out of hours) or email [email protected]

Notes to Editors

1) Abstract available here: http://www.bcs.com/abstracts3/marker_view.asp?AbstractID=19132) Breast cancer survival statistics, Cancer Research UK: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/survival#heading-Zero3) 2013 SIGN Guideline: http://www.sign.ac.uk/pdf/SIGN134.pdf and 2015 ESMO Guidelines: https://www.annonc.oxfordjournals.org/content/26/suppl_5/v8.full.pdf+html4) Cardiovascular Disease Statistics 2015, British Heart Foundation: https://www.bhf.org.uk/research/heart-statistics5) “Heart health and cancer treatment booklet” produced with Macmillan Cancer Support available here: https://www.bhf.org.uk/heart-health/conditions/heart-failure

About the British Cardiovascular Society (BCS)BCS is the voice for those working in cardiovascular health, science and disease management in the UK; we aim to promote and support both the healthcare professionals who work in cardiology and the patients for whom we want to encourage the best possible treatment. Our members are healthcare professionals, working in the field of cardiovascular health.Find out more at bcs.com

British Heart FoundationCoronary heart disease is the UK’s single biggest killer. For over 50 years we’ve pioneered research that’s transformed the lives of people living with heart and circulatory conditions. Our work has been central to the discoveries of vital treatments that are changing the fight against heart disease. But so many people still need our help. From babies born with life-threatening heart problems to the many Mums, Dads and Grandparents who survive a heart attack and endure the daily battles of heart failure. Every pound raised, minute of your time and donation to our shops will help make a difference to people’s lives. Find out more at bhf.org.uk

The University of DundeeScottish University of the Year, Times / Sunday Times Good University Guide 2016 Our School of Medicine is:• Ranked 1st in Scotland and 5th in the UK for Medicine in the Guardian University Guide 2017• Ranked 7th in the UK for impact on global health by the All-Party Parliamentary Group on Global Health• Dundee’s Medical graduates consistently rank in the top 5 for graduate preparedness for early postgraduate training.

Meeting Link: British Cardiovascular Society Conference, June-2016