Is lung cancer chemoradiation safe with low heart function?

Question

Hi doctor,

My husband is 59 years old and a known case of an excessive smoker (around 30 years). He has been recently diagnosed with squamous cell lung carcinoma, stage 3A. Chemoradiation is the proposed treatment by his radiation oncologist.

However, he had an MI around eight months back and is currently on medication with clopidogrel and atorvastatin. The recent echocardiogram has revealed an ejection fraction of 38 percent, as mentioned by his cardiologist.

The issue here is that we are worried about the effect of stress due to chemo and radiation, considering the cardiac status of my husband. Secondly, he has diabetes mellitus with an HbA1c of 9.1, which is yet to be brought under control.

Can you please suggest whether it is safe for him, with such a cardiac profile, to go ahead with the treatment?

Please help me.

Thanks in advance for your time and advice.

Answer 1

Hi,

Welcome to icliniq.com.

I am sorry to hear about your husband's problem; dealing with different medical problems at one time could obviously become quite stressful for him.

To provide my answer regarding your husband's illness adequately, stage 3A squamous cell lung cancer is a serious yet still curable problem. Chemoradiation at this stage is usually suggested because it has the best possibility of controlling the disease process.

However, it is really good that you worry about your husband's condition because of his general medical history. He had a myocardial infarction eight months ago, and he has low cardiac performance with an ejection fraction equal to 38 percent, which corresponds to heart failure with reduced ejection fraction. Moreover, his diabetes is poorly controlled, with HbA1c equal to 9.1.

This notwithstanding, therapy is still possible, provided that it is individually tailored. Indeed, many patients with impaired heart function have been on chemotherapy and radiotherapy without complications, but treatment regimens are usually altered to enhance safety. This may include using less cardiotoxic agents, dose reduction, or changes in timing. Radiotherapy is usually targeted to avoid radiation of surrounding tissues, including the heart, but some cardiac exposure is possible, depending on the tumor position.

The cardiac drugs he currently takes, including clopidogrel and atorvastatin, can be continued because they do not have any interactions with cancer-related drugs. However, all the drugs he uses will be reviewed for safety concerns, including bleeding.

It is equally essential to optimize his medical status before and during cancer treatment, since it will help him tolerate treatment better. He should have optimal heart failure management, achieve optimal fluid balance and proper glycemic control, because poorly controlled diabetes can make him susceptible to infections and negatively impact healing processes.

To put it simply, what is needed in this case is a fine balance between adequate cancer therapy and preservation of cardiac functions and improvement of metabolic status. For that, a multi-specialty treatment that includes specialists in oncology, cardiology, and possibly endocrinology is preferable to a mono-speciality treatment.

Thus, while a low EF does increase the risk factor, it does not absolutely preclude treatment. Treatment should be carefully customized depending on his reaction to it and tolerance. Moreover, it can be asked whether a cardio-oncology service exists because that way, cancer and cardiac treatment will be coordinated better.

Many people who find themselves in the same position successfully undergo treatment.

I hope this helps.

Thank you.