Heart damage caused by chemotherapy is worse in cancer patients who also have diabetes, a new study has warned. Researchers in the study investigate factors that could affect the likelihood of patients having heart damage after treatment with anthracyclines. “Cardiotoxicity induced by chemotherapy with anthracyclines is being increasingly reported, mainly because a smaller proportion of patients now die from cancer,” said Ana Catarina Gomes, from Hospital Garcia de Orta in Portugal. “In the coming years this cardiotoxicity looks set to increase the burden of heart failure in cancer survivors,” said Gomes.
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“The good news is that cardiotoxicity can be reversible in the early stages before overt heart failure develops,” she said. “Surveillance programmes are hugely beneficial, particularly in the first year of treatment when up to 80 per cent of the systolic dysfunction develops,” she added.
The hospital has a surveillance programme to monitor cancer patients who receive anthracycline-based chemotherapy. Clinical and echocardiographic evaluation is conducted before, during and after chemotherapy, regardless of whether or not the patient has symptoms. The aim is to detect cardiotoxicity early so that heart failure can be prevented. The study included all 83 patients in the surveillance programme, of whom 54 had breast cancer, 20 had lymphoma and nine had gastric cancer.
For each patient, data was collected on demographics, cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidaemia and smoking) previous cardiovascular and non-cardiovascular diseases and type and cumulative dose of anthracyclines. Echocardiographic evaluation included heart chamber dimensions, systolic and diastolic function, ejection fraction and global longitudinal strain.
Measurements were performed before chemotherapy was started, during treatment, and after the end of chemotherapy. Researchers tested the impact of each risk factor on changes in echocardiographic data from baseline to follow-up. Echocardiographic data were compared between patients with different types of cancer. A total of 39 patients were treated with doxorubicin and 44 received epirubicin. Cumulative doses were within recommended ranges. Patients were 52 years old on average (range 39 to 65 years) and 78 per cent were female.
Some 31 per cent had hypertension, seven per cent had diabetes, 16 per cent had dyslipidaemia, and 16 per cent were smokers. Patients with hypertension showed a trend towards greater reductions in ejection fraction. Patients with diabetes had a significantly greater decrease in global longitudinal strain during treatment, despite having baseline levels similar to non-diabetics.