Protecting the Heart During Cancer Treatment 

By Ryan Neely, Ph.D. 

Thinking Past Chemo 
Surviving cancer is a grueling battle from diagnosis through remission. Even so, more people than ever are winning their fight – helped in part by increasingly powerful treatments that kill cancer in innovative new ways. But greater survival means an increasing need to address the scars that fighting cancer leaves behind – including lasting damage to the heart caused by many of these same life-saving drugs. Survivors can be up to five times more likely to develop cardiovascular disease than the general population, and patients treated for common cancers like colon, melanoma, bladder, or uterine become more likely to die from heart-related conditions than cancer recurrence less than 10 years after their initial diagnosis^1,2.  Thanks to scientific and medical breakthroughs, we’ve made great strides in our ability to treat cancer – a huge challenge – but now we also need to take steps to make sure patients aren’t trading one disease for another.  

A Moving Target 
Not everyone will develop heart damage from cancer treatment. But approximately 1 in 3 patients receiving cancer therapy will have cardiovascular complications which may manifest hours, weeks, or even years after starting treatment^3,4. Complicating matters further is that different classes of cancer drugs damage the heart in their own way – and new classes of drugs are hitting the market every year. For example, cardiotoxicity caused by anthracyclines – drugs like doxorubicin and daunorubicin – have been known for years to reduce ventricular ejection fraction. In other words, they reduce the heart’s capacity for pumping blood, essentially mimicking the effects of heart failure. Conversely, new treatments like immune checkpoint inhibitors have been associated with myocarditis – inflammation of the heart muscle – which is less common but can carry a mortality rate of 46%⁵. Groups like the National Comprehensive Cancer Network (NCCN) publish regular guidelines on best practices for managing these risks. However, the evolving cancer care landscape and lack of prospective data on many new treatments make staying ahead of heart damage a significant challenge.  

The Sooner the Better
As with many aspects of healthcare, prevention is by far the best option to preserve long-term health. A recent study found that prompt detection of cardiotoxicity due to anthracycline treatment followed by initiation of heart failure therapy allowed 82% of patients to recover⁶. These data provide hope for patients undergoing these potent therapies. However, these patients underwent a significant number of ultrasonic heart imaging procedures (echocardiogram): before starting therapy (baseline), every 3 months during chemotherapy, at the end of treatment, every 3 months during the first year after chemotherapy, every 6 months during the following 4 years, and yearly afterward. The reality is that these additional screenings add a significant burden for patients who are already booked for regular chemotherapy and radiation appointments. Furthermore, many oncologists and oncology clinics, especially in rural areas, lack access to the equipment and expertise necessary to perform and interpret these screenings. As cancer survivorship grows, we need better tools to manage heart health during cancer treatment and beyond.  

New Technology for New Challenges
The growing scope and severity of this challenge captured our attention and led to the formation of Skribe Medical. Our team brings together expertise in novel wireless medical devices, cancer drug discovery, and wearables – a unique combination of elements that we believe can be allied in the service of protecting the hearts of cancer patients. Our team is united in these core beliefs: 

1. Clinical monitoring must extend beyond the clinic. Point-of-care diagnostics provide invaluable insights, but their intermittent nature delays health insights, often missing the ideal time for intervention. 

2.  Convenience fosters adherence. Our goal is to help alleviate clinical burden, not to make clinical care more complicated. A health monitoring solution is only useful if it is used. 

3. Data quality is the key. The best algorithms are only as good as the data they have available. High quality data is the bedrock to actionable predictions. 

4. Patients must be engaged for optimal care effectiveness. A system that helps patients understand their condition and gives them agency in their healthcare journey will lead to better health outcomes. 

Our mission at Skribe is simple: to improve cardiotoxicity detection for cancer patients. We aim to accomplish this with wearable devices that match the ease and comfort of consumer wearables with the accuracy and clinical validity of point-of-care diagnostics. We’ve begun building a novel technology solution that we believe can accomplish this goal, and we’re excited to share our solution in the near future. 

References 

1. Raisi-Estabragh, Z., Murphy, A.C., Ramalingam, S., Scherrer-Crosbie, M., Lopez-Fernandez, T., Reynolds, K.L., Aznar, M., Lin, A.E., Libby, P., Cordoba, R. and Bredsen-Masley, C., 2024. Cardiovascular considerations before cancer therapy: gaps in evidence and JACC: CardioOncology expert panel recommendations. Cardio Oncology, 6(5), pp.631-654. 

2. Strongman, H., Gadd, S., Matthews, A.A., Mansfield, K.E., Stanway, S., Lyon, A.R., dos-Santos-Silva, I., Smeeth, L. and Bhaskaran, K., 2022. Does cardiovascular mortality overtake cancer mortality during cancer survivorship? An English retrospective cohort study. Cardio Oncology, 4(1), pp.113-123. 

3. Sadler, D., Arnold, A., Herrmann, J., Daniele, A., Silva, C.M.P.D.C., Ghosh, A.K., Szmit, S., Khan, R.I., Raez, L., Blaes, A. and Brown, S.A., 2021. Reaching across the aisle: cardio-oncology advocacy and program building. Current oncology reports, 23, pp.1-13. 

4. Curigliano, G., Cardinale, D., Dent, S., Criscitiello, C., Aseyev, O., Lenihan, D. and Cipolla, C.M., 2016. Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management. CA: a cancer journal for clinicians, 66(4), pp.309-325. 

5. Moslehi, J.J., Salem, J.E., Sosman, J.A., Lebrun-Vignes, B. and Johnson, D.B., 2018. Increased reporting of fatal immune checkpoint inhibitor-associated myocarditis. The Lancet, 391(10124), p.933. 

6. Cardinale, D., Colombo, A., Bacchiani, G., Tedeschi, I., Meroni, C.A., Veglia, F., Civelli, M., Lamantia, G., Colombo, N., Curigliano, G. and Fiorentini, C., 2015. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation, 131(22), pp.1981-1988.