Dr. Husam Abdel-Qadir

Life After Breast Cancer

Understanding heart health post-chemotherapy

Survival rates after breast cancer have improved substantially due to advances in screening and treatment. Yet, many treatments can damage the heart, resulting in a three-fold higher risk of heart failure. While we know there is an increased risk of developing heart disease for breast cancer survivors, there is not much data available about how to properly screen for and manage this risk.

“Most of the information we currently have indicates that many breast cancer survivors can be left with a weakened heart following chemotherapy, but we don’t really know much about the long-term risk of serious heart disease,” says Dr. Husam Abdel-Qadir, scientist at Women’s College Research Institute (WCRI) and cardiologist at Women’s College Hospital (WCH). “It is possible that this risk of serious heart disease is not as irreversible as we think as long as we are able to implement more effective prediction and management strategies for these patients.”

Despite the perceived necessity of cardiac imaging before and during chemotherapy, the recommendations for their use are mostly based on expert opinion rather than data. In a pilot study, Dr. Abdel-Qadir found that only three per cent of routine cardiac imaging tests provided to breast cancer patients getting a treatment called trastuzumab (or Herceptin®) led to a change in their care. Furthering these findings, the Wholesale cardiac Imaging Surveillance with Echocardiography and Radionuclear assays during breast cancer chemotherapy (WISER)study led by Dr. Abdel-Qadir is using data collection to determine if these tests are an efficient use of healthcare resources and patients’ time.

“The WISER study will be the first to investigate on a large scale whether cardiac imaging performed while receiving certain types of chemotherapy is useful in making treatment decisions,” adds Dr. Abdel-Qadir. “We hope that data from the WISER study will allow us to pick and choose tests more appropriately based on individual risk, rather than the current one-size-fits-all method.”

Dr. Abdel-Qadir and his colleagues also recently developed a prediction model that estimates the probability of major adverse cardiovascular events, such as hospitalization or death, within five to 10 years of chemotherapy based on a woman’s age and risk factors. With improved screening and prediction models, clinicians will be able to determine measurable risk for heart disease to better guide their decision-making during cancer treatment.

Care after chemotherapy is another area of focus for Dr. Abdel-Qadir, as heart disease among women who are breast cancer survivors may not progress to serious heart failure unless they also have other risk factors, like pre-existing heart disease, hypertension or diabetes. In order to better understand how heart disease develops following chemotherapy, Dr. Abdel-Qadir and multiple partners across WCH have launched Diabetes, Inflammation, left ventricular dysfunction And Lifestyle After Breast Cancer (DIAL-ABC). The study will also examine how exercise-based cardiac rehabilitation may reduce that risk. DIAL-ABC is a collaboration at WCH between the cardiology division, endocrinology division, After Cancer Treatment Transition (ACTT) clinic and the Women’s Cardiovascular Health Initiative (WCHI). Breast cancer survivors will be invited to enrol in DIAL-ABC when they visit the ACTT clinic following their cancer treatment. Participants will then join the preventative cardiac rehabilitation program offered through the hospital to help them establish long-term lifestyle changes to hopefully reduce their risk of developing heart disease.

“Programs like DIAL-ABC can help us change how we approach care for breast cancer survivors,” notes Dr. Abdel-Qadir. “If we are able to effectively manage the risk of heart disease in this population through preventative strategies such as cardiac rehab, this would have great implications on which cancer treatments we choose for patients. My hope is that this research is able to shift our focus from worrying about using certain types of chemotherapy because they may damage the heart to providing the best treatment for curing a patient’s cancer, followed by prevention and management of potential future heart disease.”