Few young cancer survivors confront higher risk of premature heart failure

WASHINGTON: Imagine beating cancer only to realise that the medication that saved your life also came with a brand-new health risk: heart failure.

Anthracyclines, a particular class of chemotherapy that breaks the DNA in cancer cells, have been reported to increase the risk of heart failure among young adult cancer survivors (between the ages of 18 and 39 at diagnosis) by 2.6 times.

The first study to estimate the risk of heart failure among young adult cancer survivors treated with anthracyclines included 12,879 young adult cancer survivors. The incidence of heart failure was highest for cancer survivors of leukaemia.

Additionally, survivors of kidney, lymphoma, bone and breast cancer also had a higher incidence of heart failure compared with study participants diagnosed with other cancer types. These types of cancer are more likely to be treated with anthracyclines.

"Thankfully, people are increasingly surviving early-onset cancer, but once they do, they're at risk of long-term side effects, like heart failure and infertility," said corresponding study author Elizabeth Hibler, assistant professor of epidemiology and prevention at Northwestern University Feinberg School of Medicine. "I'm interested in not only helping people survive their cancer but once they do, helping them improve their health and longevity as cancer survivors."

The study was published May 16 in the journal JACC: cardio-oncology.

The mean age of heart failure diagnosis was 32 years old, which not only indicates an increased risk but also early onset of heart failure, said senior study author Dr. Sadiya Khan.

“We often think about heart failure as a disease people get when they are old, but this work highlights that this is also a short-term risk for patients who survive cancer,” said Khan, assistant professor of cardiology and epidemiology at Feinberg and a Northwestern Medicine physician. “It raises awareness for patients and clinicians to monitor symptoms and consider strategies for prevention.”

More about anthracycline chemotherapy

The relationship between anthracycline chemotherapy and heart failure risk also has been shown among childhood and older adult cancer survivors, but this is the first study to estimate the risk of heart failure among the young adult population.

Hibler said while anthracycline chemotherapy is effective at treating cancer, physicians are moving away from it because of the cardiotoxic side effects.

“What we’re trying to do is apply our findings to studying other cancer medications to try to understand if they impact the heart,” Hibler said. “Our goal is to improve early detection because there are early treatments for heart failure if the patient is showing signs.”

The results of this study provide more evidence for the overlap between cardiovascular disease and cancer, but future research is needed to understand if other (newer) types of cancer treatment also can impact the risk of heart failure, even for young people, Hibler said. Future research also is needed to understand how shared risk factors can impact the risk of both cancer and heart disease.