Posts Tagged ‘chemotherapy’

Double Winner: Patrick Shaw Beat Cancer, Then Heart Disease

When my sister-in-law Carol Peerce died suddenly at age 49 exactly three years ago, it was discovered that radiation-induced heart disease likely led to her heart attack and eventual death.

It turns out the radiation therapy to treat her Hodgkin’s lymphoma 30 years previously had damaged Carol’s heart.

At my wife Margie’s suggestion, I looked into this condition and sure enough found medical evidence that radiation, and chemotherapy, given to Hodgkin’s lymphoma patients put them at risk for later heart problems.

Then I found out that my friend Patrick Shaw, a contractor I knew in East Hampton, was one of these patients as well.

Pat had been diagnosed with Hodgkin’s lymphoma at age 29 and received multiple sessions of radiation therapy and chemotherapy that included heart-toxic anthracyclines.

Little did he know that the radiation therapy and chemotherapy he received to cure his cancer would scar his heart and lead him to have several silent, near-deadly heart attacks and a stroke 20 years later.

Pat’s story, and the heart risks of cancer therapies, are the basis of the cover story for the just released May 2013 issue of Heart Insight magazine.

Heart Risks from Radiation Therapy

Many people survive their cancers, but end up dying of cardiovascular disease.

Among Hodgkin’s lymphoma patients who have received radiation, cardiovascular disease is one of the most common causes of death.

Studies have shown that these patients have an increased risk for coronary artery disease, heart valve disease, congestive heart failure, pericardial disease (disease of the heart lining), and sudden death.

The basic mechanism appears to be radiation-induced damage to the lining of blood vessels.

Compared to the general population, Hodgkin’s lymphoma patients have higher heart risks if they were treated before age 21 or had radiation to the central part of the chest, which increases the risk of death from a fatal heart attack by 1.5 to 3 times.

In addition, a woman who received chest radiation therapy for breast cancer has a 63% increased risk of cardiac death.

With improvements in radiation techniques, including smaller amounts of radiation aimed at specific body areas, the risk of cardiovascular complications has declined.

But patients treated through the mid-1980s have a higher risk of congestive heart failure and heart valve problems.

Pat’s cardiologist, Ronald Drusin, MD, Professor of Clinical Medicine at New York-Presbyterian Hospital, says: “If you had chest radiation for lymphoma in the central part of the chest and have chest pains or tightness and shortness of breath, you should be evaluated by a cardiologist.”

Road to Recovery

For Pat, Dr. Drusin decided that stents to reopen the blocked coronary arteries in his heart were a better choice than bypass surgery because of radiation-induced scarring in Pat’s heart.

Pat felt better after the procedure, although his recovery was complicated by a stroke.

Today, Pat’s prognosis is fine, says Dr. Drusin “as long as he takes good care of himself, which he does.”

Pat is back to work and now pays close attention to his exercise and diet.

As the family chef, he cooks heart-healthy meals containing more whole grains and vegetables, no salt and fewer processed foods.

He checks his blood pressure regularly and takes daily medications, a beta-blocker and baby aspirin, to keep his heart healthy.

On weekends he stays busy with his three sons’ lacrosse games and other activities, including his favorite hobby, building bird houses.

Pat has some simple advice to anyone with symptoms of heart disease:

“As soon as you are not feeling well, get to a doctor,” he says.

“You have to be proactive.

You are in charge of your own heart.”

That’s particularly true if you had radiation or chemotherapy to treat a cancer when you were younger.

Early Chemotherapy Can Compromise Female Fertility

A number of chemotherapy or anticancer medications may compromise a woman’s fertility.

Now it appears that the earlier the cancer diagnosis, the higher the risks for later infertility.

Some chemotherapy medicines, like those in the alkylating agents group, can cause infertility.

These types of chemotherapy medicines can be used to treat many different kinds of cancer, not just cancers that affect the reproductive organs.

Chemotherapy mostly causes infertility by reducing the number of eggs in your ovaries or by causing early menopause.

Many women who receive chemotherapy and radiation for Hodgkin’s disease go into premature menopause because of damage to their eggs or follicles.

Those exposed to both therapies suffer more damage than those who receive only one therapy.

Focusing on longer-term, age-specific outcomes associated with chemotherapy, researchers at the University of California at San Francisco have found that the younger a woman is when diagnosed with cancer, the more likely she will experience early menopause.

Key findings from a survey of more than 1,000 women in a California cancer database, now available online in the journal Cancer, include:

* From 5-10% of women reported acute ovarian failure, which increased significantly with age at diagnosis.

* The incidence of infertility increased significantly with age at diagnosis.

For example, for women with Hodgkin’s disease, 18% were infertile at age 20 compared to 57% at age 35.

* Using age as a predictor of early menopause in non-Hodgkin lymphoma, more than half of women age 20 at diagnosis experienced menopause early compared to one in 6 who were age 35 at diagnosis.

“We noted proportions of infertility among cancer survivors that appear considerably higher than those in the general United States population,” said lead author Joseph Letourneau, MD.

Not all women who are having cancer treatment have the opportunity to talk with a fertility specialist before beginning treatment.

Yet there are several options to preserve a woman’s fertility, including freezing embryos, eggs, or tissue from her ovaries before she goes for cancer treatment.

If you have received a cancer diagnosis, particularly if you had cancer in your 20s, ask your oncologist how you can preserve your fertility.

Fertility Options Move Beyond Sperm and Embryo Banks

Cancer treatments such as chemotherapy and radiation can cause a woman to experience premature menopause and diminish her chance of getting pregnant. Similarly, chemotherapy, radiotherapy, or radical pelvic surgery can reduce a man’s ability to produce sperm.

In fact, 140,000 men and women younger than 45 years old face a cancer diagnosis each year.

But all is not lost for those who suffer from infertility caused by cancer treatments. Many survive treatment and are still young enough to have children.

There are ways to preserve a woman’s fertility, including freezing embryos, freezing her eggs, or freezing tissue from her ovaries before she goes for cancer treatment.

In the first and most effective method, a woman can undergo an IVF stimulation cycle, and the retrieved eggs can be fertilized with her partner’s or donor sperm.

The newly created embryos are then frozen with the anticipation that she will have the embryos replaced back to her uterus when she is cured.

That’s just what Ewelina and Dominic Saputo did.

Ewelina received a leukemia diagnosis when she was 23, and she and her then finance went through the process to create and freeze embryos, according to a recent Detroit Free Press article.

Six years later, the young couple from Sterling Heights, MI, just north of Detroit, went through an IVF procedure, and they now have twin, 10-month-old boys, Julian and Antonio.

For men, sperm collected before cancer treatment can be saved for many years.

World-renowned cyclist Lance Armstrong became a father for the fourth time after his sperm were preserved before his treatment for testicular cancer.

One of the innovative techniques available to men is to obtain tissue samples with a tiny needle and then use them to fertilize an egg stored for later use, which is called testicular sperm extraction.

The newspaper article includes a nice chart of simple or minimally invasive techniques available or coming soon to leading fertility programs for both men and women.

If you receive a cancer diagnosis, ask your oncologist how you can preserve your fertility.

New IVF techniques have taken fertility preservation to a whole new level.