Cancer patients missing out on vital heart care: study

A new Australian study has found that heart patients with a history of cancer are less likely to receive the heart medications they need.

The study found that the management of risk factors for heart disease and stroke among cancer patients and survivors “was suboptimal compared to those without a history of cancer”.

Certain chemotherapy, radiotherapy and other cancer treatments are known to damage heart muscles, valves and blood vessels, and other organs. This study focused on how well cancer survivors’ risk factors for heart disease were being managed.

The study, co-authored by University of Newcastle researchers, Associate Professor Aaron Sverdlov, and Professor Doan Ngo, was published in the Journal of the American College of Cardiology. Professor Sverdlov is funded under a Heart Foundation Future Fellowship research grant while Professor Ngo is funded under a NSW Health Early-Mid Career Researcher Fellowship.

The researchers investigated the care of 320 patients who were admitted to the cardiology unit at John Hunter Hospital in Newcastle between July 2018 and January 2019. They were being treated for heart attacks, blocked arteries, atrial fibrillation (irregular heartbeat), heart failure and other heart conditions.

Sixty-nine had a current or prior history of cancer and 251 had no history of cancer. Both groups had similar risk factors for heart disease and stroke, but the researchers found a discrepancy in who was taking medications to treat their risk factors.

The researchers found:

• 58 percent of cancer patients and survivors were taking anti-platelet medications to prevent blood clots compared to 75.3 percent for the cancer-free group.
• 63.3 percent of cancer survivors in this group were taking statins, which are usually used to treat high cholesterol or unstable plaque in the arteries, compared to 79.7 percent for those with no cancer history.

Cancer patients were also slightly less likely to be prescribed ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin-receptor blockers) used to treat high blood pressure and for cardio protection, but the difference was not statistically significant.

Professor Sverdlov said previous studies suggested that cancer patients were also less likely to have bypass surgery to restore blood to blocked coronary arteries.

“We found that cardioprotective therapies are under-used in cancer patients and survivors compared to patients without a history of cancer, despite having similar risk factors for heart attack or stroke,” he said.

“The findings highlight practice and policy gaps and the need for guidelines for treating cancer patients who have signs of cardiac abnormalities.”

Professor Ngo said previous studies found that cancer patients were up to 15 times1 more likely to develop cardiovascular disease than people with no history of cancer but this public health issue was not being widely addressed

The researchers recommended a multi-disciplinary approach for treating cancer patients.

The Heart Foundation’s General Manager of Heart Health and Research, Bill Stavreski, said the study provided new evidence about an emerging area of research, known as cardio-oncology.

“Australia has one of the highest cancer survival rates in the world. The immediate focus is on surviving the cancer, but the long-term health of survivors is also important.

“I encourage cancer survivors to talk to their doctor about their risk personal risk factors for heart attack and stroke, when they are ready to do that.”