The Never-Ending Cycle of Cancer: Treatment Versus Long-Term Health

On October 22, 2024, CURE published an article entitled, “Identifying Cardiovascular Risk in Cancer Survivors,” and the title grabbed my attention. When my 27-year-old daughter Adrienne was diagnosed with breast cancer in 2019, I thought that typical side effects of treatment — nausea, fatigue, hair loss and skin damage from radiation — would be the attention of all of our worries. Little did I know what the treatment could do to her heart.

Adrienne’s cancer was triple positive, meaning it was hormone and HER2 driven. Adrienne’s oncologist called Herceptin (trastuzumab) a game changer when it came to treating HER2-positive breast cancer. The drug’s ability to block cancer cells from receiving the chemical signals that tell them to grow had given him a powerful tool to prevent recurrence. He said before it came along, he typically saw HER2-positive patients back in his care within 18 months. We were happy to know that Adrienne would be receiving Herceptin as part of her treatment plan.

But…

Herceptin can cause serious heart problems, and in our family, heart disease is the genetic gift that just keeps on giving. The potential for damage became an even greater concern when a mother who had been communicating with me regarding her daughter’s breast cancer diagnosis, shortly after Adrienne was diagnosed, told me that her daughter had died from heart complications directly related to receiving the drug.

Adrienne was regularly monitored by a cardiology team throughout the course of Herceptin. I remember sitting there waiting for her cardiologist to have a look at her electrocardiogram, hoping my daughter would not be presented with an impossible choice: protect your heart or protect against recurrence. I made her walk every day since the doctors said regular exercise was a way to help. There was a set of stairs between two levels in her neighborhood, and as her fatigue slowly but surely meant that three or four stairs at a time was all she could do before resting, my fear increased in tandem. In the end, luck was on our side, as her heart was not immediately damaged by Herceptin, and she was able to finish the full course. Also, I am sure that her body’s ability to tolerate the drug has contributed to her still being status NED (no evidence of disease).

But that’s not the only time cancer treatment has caused her heart issues.

During the six weeks of radiation treatment, Adrienne had to do a breath-hold to get her heart as far away as possible from the beams directed at her left breast. This technique is intended to reduce the side effects on the heart, but the intense radiation still damages the vessels in the chest, which can lead to major long-term heart complications. Even if it happens 20 years down the road, my daughter was 27 when she underwent treatment, so she will only be 47 if the damage manifests as heart disease. Couple that with family history, and there is too much potential that the treatment intended to save her life will take her early.

But wait… there’s more.

Adrienne’s first chemotherapy drug was doxorubicin, which is “affectionately” referred to as the “Red Devil” by patients with cancer. On top of the other ugly side effects like nausea, vomiting, hair loss and mouth sores, this drug can cause acute heart failure early in treatment or heart damage up to eight years after treatment has ended. Again, because she was 27 at her breast cancer diagnosis, this could mean that Adrienne could experience treatment-related heart complications at a very young age.

Not done yet.

Because of the hormone-positive breast cancer diagnosis, Adrienne needs to take two different drugs to suppress hormone production in her body for seven years to help prevent recurrence. Multiple studies have shown that these drugs can raise the risk of heart attack and stroke. So, on top of the potential for tissue injury from radiation, long-term heart damage from chemotherapy and issues related to a year of Herceptin, the drugs that she takes to reduce her risk of the cancer coming back combined with her family history risk means that every time she takes a pill in the morning for the next five years to extend her life, she will wonder if it will contribute to ending it early.

Ahh cancer… the never-ending story.

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