Cancer Survivorship Brings Long-Horizon Focus to Heart Health

Heart health in cancer survivorship is a growing focus as more patients are surviving cancer than ever before and cardio-oncology providers manage a wide spectrum of treatment-related heart conditions. Profound late cardiotoxicity can follow curative-intent regimens, particularly anthracycline-heavy chemotherapy, high-dose therapy with transplant, and cardiac-field radiation, necessitating long-horizon surveillance strategies.

In 2000, when she was 26 and in the early months of medical school, Dr. Dawn Mussallem collapsed on her way home from class in cardiogenic shock; her heart wasn’t pumping. Doctors soon found a 16-centimeter mass in her chest, wrapped around her heart, that had collapsed her left lung. She received a diagnosis of Stage 4 large diffuse B-cell non-Hodgkin lymphoma and was told she had three months to live if she didn’t start treatment immediately.

An intense treatment regimen of surgery, chemotherapy and bone marrow transplant followed, then radiation. She began working in medicine, gave birth to a daughter and, three weeks later, started experiencing heart failure — a state she would stay in for the next 18 years until undergoing a heart transplant in 2021.

“We've learned the hard way that, yes, some of the chemotherapies we give are very toxic to the heart and some of the radiotherapy or the radiation we give can also be, depending on positioning, potentially toxic to the heart,” she says. “For young women with a diagnosis of breast cancer, we put them on antiestrogen therapy. There is discussion [that] this poses risk of downstream effects of related heart disease because they're having hormone suppression.”

The five-year survival rate for all cancers combined is at an all-time high of 70%, according to the American Cancer Society’s 2026 annual report of statistics cited in the article. “We’re in a different era now. With so many cancer survivors, we have to start paying attention to other critical issues, like heart health,” says Dr. Michelle Bloom.

Bloom says cardio-oncology providers see a wide-spectrum of connections between cancer treatments and heart health. Survivors of cancer can develop heart failure, where the heart muscle becomes weakened or stiffened. They can also develop valvular disease, in which the heart valves can become narrowed or leaky, as well as coronary artery disease, especially in patients that have received radiation to their chest as part of their cancer treatment.

Cardio-oncology clinics manage diverse therapy-associated phenotypes including early-onset heart failure, radiation-associated coronary and valvular disease, and constrictive pericarditis, underscoring the need for multidisciplinary longitudinal care.

One survivor described another path through cancer and heart disease. He said he was diagnosed with esophageal cancer in the fall of 2021, immediately began radiation therapy and had an esophagectomy after being told he had a 30% to 50% chance of survival. He said he is cancer-free to the best of their knowledge.

He also said he was diagnosed at age 57 with ARVC, a rare, genetic heart defect or disease, and that at age 67 he is alive and kicking. He said the condition is progressive, uncurable and fatal, and that modern medicine can slow it down with the drugs he is on. He said that two months earlier he had been told the only solution was a heart transplant and that he had no interest in this.

The accounts reflect a central issue in survivorship care: cancer survivors can live for years after treatment while managing lasting cardiovascular effects and other long-term complications.