Francisco Sebastián Palacid Details Cancer Treatment Cardiotoxicity

Key Clinical Takeaways:
• Cardiotoxicity can manifest acutely within the first year of cancer treatment or surface late after a decade or two, particularly in childhood cancer survivors.
• Primary care physicians frequently become the first clinicians to detect late-stage cardiac decline as routine oncology follow-ups conclude.
• Diagnostic access via radionuclide ventriculography varies significantly across regional hospital networks, creating care disparities.

Why Does Heart Damage Appear Years After Cancer Treatment?

Francisco Sebastián Palacid, coordinator of the Cardiology Working Group at the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) and a nuclear medicine physician at the University Clinical Hospital of Valladolid, explained to El Médico Interactivo that cardiotoxicity can present acutely within the first year or emerge late, 10 to 20 years following exposure, especially in pediatric cohorts.

What Warning Signs Should Primary Care Physicians Monitor?

Because post-treatment cancer surveillance eventually transitions out of hospital oncology clinics, primary care providers frequently manage long-term survivorship care. Palacid emphasized that clinicians must watch for subtle indicators that patients might dismiss as normal aging or deconditioning. Warning signs include unexpected fatigue during routine activities, exertional dyspnoea when climbing stairs or lying flat, peripheral edema in the ankles, new-onset palpitations, and rapid, unexplained weight gain driven by fluid retention. Any of these signs, in someone who has received anthracyclines, trastuzumab, or RT to the chest, should raise concern, even if 10 or 15 years have passed since treatment, he said. Palacid noted that simply by asking these patients about these symptoms at every checkup, we can often prevent them from coming to us with established heart failure.

Who Faces the Highest Risk for Long-Term Cardiac Complications?

Risk stratification depends on cumulative exposure to specific agents and patient age at treatment. Women with breast cancer receiving anthracyclines combined with trastuzumab face elevated cardiac risk, as do lymphoma patients treated with anthracyclines paired with thoracic radiation therapy. Children and adolescents treated for cancer represent the most vulnerable demographic due to high cumulative chemotherapy doses administered while their cardiovascular systems are actively developing.

How Do Healthcare Systems Monitor and Diagnose Myocardial Damage?

Radionuclide ventriculography measures myocardial performance with high reproducibility before, during, and after chemotherapy courses. However, SEMNIM highlighted substantial resource disparities across Spain’s autonomous communities and individual hospital tiers. While large referral centers maintain advanced equipment and high procedural volumes, medium-sized hospitals frequently experience diagnostic drift when specialized nuclear cardiology personnel depart and positions remain unfilled.

How Does Breast Cancer Radiation Therapy Affect the Heart?

In a separate development reported by the National Health and Medical Research Council (NHMRC) in Australia, where breast cancer is the second most commonly diagnosed cancer and over 50% of patients receive radiation therapy, delivering radiation to the chest area exposes the heart to unintended radiation doses that elevate long-term coronary event risks. Professor Joerg Lehmann, a radiation oncology medical physicist whose research has always focused on cancer and improving patient care, noted that because the heart happens to be near the treatment area, the goal is to minimise this unwanted exposure. To achieve optimal radiation delivery and protect the heart, patients are treated under Deep Inspiration Breath Hold (DIBH), a technique where holding the breath during breast radiotherapy effectively shifts the heart away from the treated area. The project received $417,138 in funding through a 2017–2022 grant, and Professor Lehmann hopes that increased treatment accuracy will lower side effects, possibly improve cure rates, and benefit disadvantaged patients by shortening treatment duration.

Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.