By Dr Abhinay Tibrewal
Consultant – Cardiology, HCG Cancer Centre, Kolkata
Modern cancer care has transformed outcomes, but saving a life should never come at the hidden cost of heart health. With cancer responsible for nearly 10 million deaths worldwide in 2024, according to the World Health Organization, better outcomes and longer survival make protecting the heart an integral part of cancer care.
Understanding the risk
Chemotherapy and chest radiotherapy, as well as targeted therapies and immunotherapies, can sometimes affect the heart muscle, coronary arteries, blood pressure or rhythm. This cardiotoxicity may present as cardiomyopathy, heart failure, coronary artery disease, arrhythmias or hypertension. The risk is higher in patients with pre-existing heart disease, diabetes, hypertension, advanced age or frailty—but it need not prevent appropriate cancer treatment.
Start with a baseline
A cardiac assessment before therapy begins is therefore essential. It includes a clinical evaluation, ECG and, where indicated, echocardiography and relevant blood tests. The extent of assessment is tailored to the treatment planned and the patient’s individual risk profile.
Monitor during and after treatment
Monitoring must continue through the cancer journey. Periodic reassessment can detect changes in cardiac function, blood pressure or rhythm before they become serious. Patients should promptly report breathlessness, chest discomfort, palpitations, unexplained fatigue, dizziness or swelling of the feet.
Not every risk appears weeks or months later. Some chemotherapy drugs and other intravenous cancer treatments can cause infusion-related reactions during a session. Sudden chest discomfort, palpitations, breathlessness, wheeze, dizziness, rash or a sharp change in blood pressure warrants immediate attention. These symptoms do not automatically mean a cardiac complication; however, vital signs should be checked, the infusion may need to be paused, and the treating team must assess the patient before restarting it.