Caring for your heart during and after Chronic Myeloid Leukemia (CML) treatment For patients and families Reading this booklet can help you learn Why you were referred to the Ted Rogers Program in Cardiotoxicity Possible side effects of your CML treatment How to treat your cardiac risk factors What tests we use to monitor your health Sections adapted from Testing For Coronary Artery Disease (D-5111). Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca 2017 University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only. Author: Linda Belford Created: 12/2017 Form: D-8729
Chronic Myeloid Leukemia and my treatment Chronic Myeloid Leukemia (CML) is a cancer of the blood cells. How you and your health care team decide to treat your Chronic Myeloid Leukemia (CML) will depend on the phase you are in. If you are the chronic phase, your doctor will usually prescribe a medicine called Tyrosine kinase inhibitors or TKIs. There are different kinds of TKIs such as: Imatinib (Brand name Gleevec) Dasatinib (Brand name Sprycel) Nilotinib (Brand name Tasigna) Bosutinib (Brand name Bosulif) Ponatinib (Brand name Iclusig) Treating CML with TKI medicines allows people to live longer. TKIs are a very important part of this type of cancer treatment. But like many medicines and treatment, there is a small chance that you may experience side effects. There is a small chance that of having a heart attack, stroke and pulmonary hypertension (high pressure in the lungs). What can the Ted Rogers Program in Cardiotoxicity Prevention do for me? Risk means the chance that something will happen. When someone with CML also has diabetes and high cholesterol, for example, there is a greater chance of having a heart problem during cancer treatment. Any heart and blood vessel disease that is not well controlled can cause heart damage, such as a heart attack or stroke. We call this a cardiovascular event. 2
The cardiologist and care team at the Ted Rogers Program in Cardiotoxicity Prevention Clinic will treat any risk factors you may have during and after your cancer treatment. Treating your risk factors lowers the chances of having a heart problem during your cancer treatment. What are the risk factors for heart and blood vessel disease? Several risk factors increase the chances of developing blockages in your heart arteries or other blood vessels. Some of them you cannot change such as age, gender and family history. Risk factors that CAN be changed include: 1. Smoking 2. Diabetes 3. Exercise 4. High cholesterol 5. High blood pressure 6. Physical inactivity 7. Being overweight How do I know if I m having a cardiovascular event? Watch for these symptoms: Chest pain or discomfort Shortness of breath or cough that you did not have before Difficulty lying flat Feeling dizzy or light-headed Fast beating heart Swollen legs 3
Pain or discomfort in your legs, thighs or buttocks that gets worse when you exercise Leg ulcers (sores) that don t heal Sudden resting pain in lower legs Sudden weakness in arms or legs and or slurred speech Talk to your oncologist or cardiologist if you have any of the symptoms above or go to your nearest Emergency Department if you think you should. What to expect during your visit to the Ted Rogers Program in Cardiotoxicity Prevention Clinic As part of this program, your cardiologist and oncologist will work together to best treat your condition. You will have a full heart exam and you may need to do some tests to make sure your care team has all the information they need. Some of the tests you may need include: 1. Cardiovascular risk assessment A survey to estimate your risk of a cardiovascular event. 2. Electrocardiogram (ECG) This test records the electrical activity of your heart. It can find problems related to your heart rate and heart rhythm. 3. Echocardiogram This is an ultrasound of your heart. It will show if your heart is pumping normally. Using this test and new research, your health care team can spot heart problems even before they develop. 4
4. Ultrasound of the lower legs This test looks at the how the blood is flowing in the arteries of your legs. It can find any blockage. 5. Exercise Stress test An exercise stress test measures how your heart deals with the stress of physical activity. You are connected by wires to an ECG monitor. It checks your heart s electrical activity and your blood pressure. 6. Coronary angiogram and right heart catheterization A heart catheterization (also called an angiogram) helps your doctor get information about your heart. This includes how well your arteries work and your heart and lung pressures. You have major coronary arteries that supply your heart muscle with blood. Each main artery has many branches like the roots of a tree. A heart catheterization takes pictures of these arteries. This will help your doctor see your arteries better. 7. Cardiac Magnetic Resonance Imaging (MRI) MRI uses a magnetic field and radiowaves to make detailed pictures of your heart. No e-rays (radiation) are used, so it is very safe. This test can show the pumping action of your heart. It is the most accurate way to measure how well the heart is working. MRI can also show details such as swelling and scars which cannot be shown well in other tests. 5
8. Surveys Your health care team may ask you to fill out a survey. We will keep all the information we collect private and safe. Your answers and comments will help your care team better understand your symptoms, your overall health and health care needs. 9. Cardiopulmonary stress test This is an electrocardiogram or ECG done while you are riding a stationary bicycle. This may be done at the end of your chemotherapy treatment to measure how exercise affects your heart and better understand your symptoms. What can I do to keep my heart and blood vessels healthy? Watch for symptoms of heart or blood vessel problems (see list on page 3). Tell your cardiologist if you develop symptoms so you can get treated right away. Visit your cardiologist and the heart team at the clinic and complete your tests as scheduled. Follow these tips for healthy living. Exercise Try to stay active during your cancer treatment. Aim for some exercise or physical activity each day. Even 10 minutes of activity has health benefits. Increasing physical activity after treatment can help: Strengthen your muscles (including your heart) Improve your fitness level Lower your blood pressure Give you more energy 6
Do not smoke If you smoke and need help to stop, lots of support is available: Call the hospital pharmacy at 416 340 QUIT (4075) about programs to help you quit Talk to your family doctor Ask your public health unit about support groups in your community Get help online at www.smokershelpline.ca Keep blood pressure under control Having good blood pressure control helps to prevent damage to your heart and blood vessels. Eat foods that are low in salt and exercise regularly to help lower blood pressure. We will monitor your blood pressure and give you medicine if needed. Many patients need more than one medicine to control blood pressure. Good cholesterol control We will check your cholesterol level to see if it is within the right target range. There are different targets depending on your other health conditions. If your cholesterol is above target, sometimes changing your diet alone may be enough. If not, you may need to take medication. 7
Keep diabetes under control When blood pressure is high, it puts stress on the body. This can cause damage to the heart, brain, kidneys and eyes. High blood sugar levels are a risk factor for high blood pressure. People with diabetes are 2 to 3 times more likely to get heart disease or have a stroke at an earlier age. After cancer treatment, you will have follow-up visits with your cardiologist and the heart team. This is important to make sure your heart stays healthy. Where is the clinic located? Ted Rogers Program in Cardiotoxicity Prevention University Health Network, Toronto General Hospital 585 University Avenue 5NU Cardiac Ambulatory Clinics Phone: 416 340 5309 Toronto, ON M5G 2N2 My care instructions 1. 2. 3. 8