February 17, 2013

Out of the Woods: NEVER

28 Days of Heart

Day 17

Perhaps the most difficult aspect of being cured of cancer, childhood or otherwise, is the harsh reality that you are NEVER out of the woods.

Let me begin by acknowledging that I have 3 & 1/2 decades of perspective on my cancer experience, so I’ve been into the deep of the woods of late effects for quite awhile taking each one on as they declared their presence in my body, my life.

Throughout my professional life as a pediatric oncology nurse practitioner, I often shared with parents that surviving the treatment was an almost larger challenge than surviving the cancer. In my late effects clinic, I often shared with the adolescents and young adults that the challenge they now faced was surviving their cure or surviving survivorship.

Within the last week alone, I have encountered 4 survivors who carry treatment-related risk for heart disease and/or heart failure. I’d like to share their comments with you to illustrate what is happening among the survivor population.

  • A young adult 10 year survivor of Hodgkins Lymphoma treated with mantle radiation [chest] and 4 cycles of ABVD: Adriamycin, Bleomycin, Vinblastine, and Dacarbazine

Cardiology performed an EKG that looks at electrical conduction and an echocardiogram that is an ultrasound of the heart that gives you a read on heart function. This young lady was informed that given that it had been 10 years and there was no evidence of heart damage, she was out of the woods.

  • A mid-50’s adult 15 year survivor of early stage breast cancer treated with chest radiation and chemotherapy, including Cytoxan, Adriamycin, and Taxol had her FIRST echocardiogram done recently; there were no baseline studies done before the start of her therapy.

She said to me, “Apparently, I was lucky as there is no damage; mild mitral back flow likely not related to treatment history.” Again, 15 years out with no evidence of heart damage and the message is you are out of the woods. Repeat echocardiogram in 3 years.

  • a young lady off therapy for less than a year treated with a regimen that included Adriamycin went in for routine follow up including an echocardiogram.

“Evidence that the decline seen in her heart while on therapy had ‘rebounded’ to normal.”

  • another adult survivor of early stage breast cancer reported evidence of cardiac decline while on a Herceptin-Adriamycin cocktail; herceptin stopped and replaced with cisplatinum; heart function bounced back to normal.

“PHEW: dodged that bullet.”

Each of these individuals is a part of a treatment generation that learned quite a bit from my treatment generation which I affectionately refer to as the nuclear option generation of cancer therapy; therefore, to step out and say their experience will mirror my would be irresponsible and simply not true.

Four things I know:

  1. Chest radiation and Adriamycin ARE risk factors for Coronary Artery Disease and progressive cardiomyopathy
  2. Many cancer survivors carry age-related risk factors and treatment-related risk factors and health screenings need to be cognizant of both
  3. Late effects are not ruled out based on one test result at one point in time; late effects emerge as the time since the end of therapy increases
  4. The forest is heart failure and the trees are lifelong follow up including echocardiogram, left heart catheterization, recognition of signs and symptoms of cardiac decline, and knowledge of your treatment history

Despite the fact that we, survivors, may never be out of the woods, we can make sure we see the forest because of the trees.

“Above ALL else, Guard your Heart, the wellspring of LIFE.” Proverbs 4:23

On tap for tomorrow, a few of my favorite girlie-girl products that add bling to living with chronic conditions.

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