Kris Johnson survived Stage II Hodgkin’s Lymphoma. Now, the treatment that saved her life more than 20 years ago likely led to a new health threat that is the biggest killer for women: heart disease.
“I’d always thought my long-term health issues were cancer related so that was always my focus,” Johnson said. “Being told I had heart disease really shocked me.”
For patients like Johnson, a resident of Acworth, radiation treatment is a cruel double-threat. It sickens the patient as it kills cancer and it can lead to heart problems for long-term cancer survivors. For specialists like Dr. Jyoti Sharma, it’s a growing concern.
According to Sharma, a cardiologist with the Women’s Heart Program at Piedmont Atlanta Hospital, between 10 to 30 percent of breast cancer and lymphoma patients develop radiation-induced heart disease within five to 10 years after treatment. Among cancer patients who receive chest radiation and survive cancer, cardiovascular disease is the most common non-cancer related cause of death. Meaning: In the long term, if they don’t die from cancer, they may die from heart disease.
Johnson, 47, was a 22-year-old at the University of West Georgia when doctors diagnosed her with lymphoma and immediately started her on an aggressive regimen of radiation followed by chemotherapy. They discussed possible side effects; heart disease was not among them.
“That was not something I knew going into cancer treatment,” Johnson said.
Six months after therapy, the cancer was gone and Johnson went on with her life.
But two days after giving birth to her son in 1998, Johnson experienced significant shortness of breath. Doctors told her she was suffering from postpartum cardiomyopathy, a weakness of the heart muscle that usually occurs during the final months of pregnancy.
Even then, she said, she battled through it with the help of a Beta Blocker and routine follow-ups with her cardiologist. Resting EKG’S and echocardiograms showed improved heart muscle strength. However, these diagnostic tests were not intended to detect the presence of cardiovascular disease.
Then last August, without warning, the mother of two said she wasn’t feeling well. She was more tired than usual and experienced shortness of breath during mild exertion or even upon lying down. But more importantly, she experienced burning in her jaw, neck and down both arms. She went to see her cardiologist, who suggested she see a pulmonologist, since there was no evidence of on-going cardiomyopathy.
The pulmonologist ran tests but didn’t find anything. Maybe she had acid reflux or a hiatal hernia, he told her. An evaluation by a gastroenterologist returned negative results again. He noted there is strong evidence that radiation treatment and heart disease are linked and recommended Johnson get a stress test as soon as possible.
In November, Johnson went back to the cardiologist for a nuclear stress test. Just minutes into the test, her EKG turned completely abnormal and the procedure had to be stopped. A few days later, doctors performed a catheterization and discovered Johnson had two blockages in her coronary artery: One 95 percent blocked and the other 100 percent blocked.
“There was really good reason for why I wasn’t feeling well and it proves you have to be your own best advocate and be persistent,” Johnson said. “Symptoms are kind of like whispers that are telling you something is not right.”
Sharma had seen cancer patients who developed heart conditions like Johnson before.
“Kris’ diagnosis did not come as a surprise,” she said. “Prior to practicing at Piedmont Heart, part of my training included working at MD Anderson Cancer Center, so looking out for heart conditions in cancer patients and survivors is always at the top of my mind.
“If you’ve had any type of cancer in the past, I want to know about it when you come see me. Anyone that’s had radiation to the chest is especially at risk for heart disease later in life and it is important we keep an eye on these patients.”
While cancer treatment can have a crippling effect on patient’s hearts, Sharma said cardiologists and oncologists have become better at protecting the heart from harsh treatments.
“Depending on the type of chemotherapy or radiation a patient is going to receive,we need to do baseline cardiac tests on them before a drop of chemo enters their body,” she said. “And if I start to see a reduction in cardiac function at any time during or after treatment, I can intervene with appropriate medicine and technology so that the patient’s heart isn’t compromised along their cancer journey.”
The incidence rates for cancer patients who turned heart patients later in life are largely based on studies of patients who had cancer a significant time ago, like Kris.
“Twenty years from now, we might see the incidence rates go down but that is something only time will tell,” Sharma said.
In December, doctors placed stents in Johnson’s heart to clear the blockage and she will soon begin cardiac rehabilitation to build her strength and endurance.
“She’s doing all the right things: staying active, taking her medications and having close follow-ups with her cardiologist,” Sharma said. “Its people like her who have the best outcomes.”
