Video: Making chemotherapy safer
Chemotherapy can save lives, but it can also permanently damage the heart. Watch as BHF researcher Dr Kerstin Timm explains how her work is trying to stop it, and cancer patient Philippa Coffey talks about her experience of heart failure.
Chemotherapy saves the lives of many patients. But its side effects can include long-term damage to the heart. Philippa Coffey was treated with chemotherapy for cancer in 2015 and now suffers from heart failure. She had to give up working full-time and often feels exhausted. We’re funding ground-breaking research to help people like Philippa.
Women – especially older women – are at the highest risk of heart problems following cancer treatment. An American study of breast cancer patients in their 70s found they were more likely to die of heart disease than of breast cancer. Another study published in 2014 found that about 12 per cent of breast cancer patients over 65 developed heart failure within three years, often as a result of the cancer drugs and treatments.
Phillipa Coffey (left) in the lab with Dr Kerstin Timm
Spotting the early signs of heart problems
Philippa, who had non-Hodgkin lymphoma, was treated with chemotherapy drugs, including doxorubicin, which is commonly used for many types of cancer. One of the possible side effects is damage to the heart muscle. This is often temporary, but can be permanent – as in Philippa’s case. Sometimes the damage doesn’t show itself until months or years later.
At the University of Oxford, we’ve funded Dr Kerstin Timm to find ways to spot the signs earlier, so damage to the heart can be prevented.
One of the possible side effects is damage to the heart muscle. Sometimes the damage doesn’t show itself until months or years later.
“Around five per cent of patients treated with doxorubicin will develop heart failure,” she says. “The risk varies hugely, and is increased by higher doses of chemotherapy, age, existing heart problems, obesity and being female. In some groups, for example elderly patients with existing heart problems, as many as 50 per cent may experience effects on their heart.
“The problem is, there is no clinical non-invasive technique to diagnose harmful effects on your heart at an early stage.”
Dr Timm is using high-tech scanning techniques to see what’s happening deep inside cells. She’s interested in free radicals – highly reactive molecules that damage cells.
“The main theory of why doxorubicin can have toxic effects is that it creates an environment where damaging free radicals are released in cells,” says Dr Timm. “This can affect energy production in the heart and, because the heart is beating all the time, having a good energy source is important.”
Using pioneering techniques to help patients
Dr Timm’s research is supervised by Professor Damian Tyler, BHF Senior Research Fellow at the University of Oxford. He has pioneered the use of a new technique called hyperpolarised MRI. This allows doctors to see how the heart muscle is using energy, in a faster and safer way than was previously possible.
The BHF has funded Professor Tyler and his team with more than £2.5m across the past five years. This included more than £760,000 in 2012 to buy a state-of-the-art hyperpolarised MRI scanner to do advanced research in patients.
It isn’t possible to give chemotherapy drugs to humans to study the effects on the heart, so Dr Timm gives rats a chemotherapy regime, similar to the kind used in people. She uses the hyperpolarised MRI to look at the way energy is generated inside cells. She wants to see if this changes as a result of chemotherapy, and whether it’s possible to spot this before there are any other signs of damage to the heart.
Hyperpolarised MRI allows doctors to see how the heart muscle is using energy, in a faster and safer way than was previously possible
The aim is to gather enough evidence so that clinical trials can be carried out in patients and eventually, these scans could be part of routine treatment.
“If this works, we could give extra scans while the treatment is happening to find the patients that will suffer damage to their heart, but before their heart starts to show physical signs of damage,” says Dr Timm. “We could then give them an extra drug that might have a protective effect, or move them to a different chemotherapy regime, if available.”
Dr Timm’s work is driven by the need to help patients. “Cardiologists here in Oxford tell me that for these patients it can be a real and debilitating problem,” she says. “We want to help those patients before they get heart failure.”
She has a personal motivation, too. “My cousin’s son had a tumour when he was seven, so he is at risk of damage to his heart from the chemotherapy,” she says. “He is 14 now, but it can take up to 10 years for the damaging effects on the heart to be felt.”
A patient’s view: Philippa's story
Philippa Coffey, 53, was diagnosed with lymphoma in July 2015. She had tumours in her spine and her thigh bone. She was told she’d need six months of chemotherapy.
“The chemo made me feel very ill,” she says. “I had every side effect under the sun, including horrific headaches. I always put on a brave face in front of other people, but there were times I cried and got hysterical at night and craved for the daylight to come. It was a very hard time.”
Although she had been given information about side effects, she doesn’t remember anyone telling her about the possibility of effects on her heart. So when she started feeling breathless after a few doses of chemotherapy, she didn’t know what it was. At first, doctors put it down to her asthma.
“I was crawling upstairs because I couldn’t breathe,” she says. “I thought I was dying because I was so ill. One time I drove to hospital for my appointment and when I got out of the car I was struggling to breathe. I had to lie down on the ground. Two paramedics had to scoop me up and put me in a wheelchair.”
Diagnosis and support
In February 2016, an echocardiogram revealed Philippa had heart failure. Her father had suffered heart failure and kidney failure at the end of his life. “I thought, this is a death sentence,” she says. “I had been through it with dad and he had died. I felt very frightened at this point.”
I don’t want to give in. If anyone can be saved from going through all this, then we’ve got to do it
Philippa was helped by Sarah Briggs, the BHF-supported nurse who had looked after her father and who she describes as “an angel”. “She explained everything that was happening and that it could be managed,” says Philippa. “She has kept adjusting my medication and it has improved my breathing. She has been fantastic. I do still struggle to walk upstairs, but it’s so reassuring to know that someone is looking after you on a daily basis.”
Philippa went back to her job in the ultrasound department of Rotherham Hospital in September 2016. At first she went back full-time, but by December she felt she could no longer cope. “I had to go part-time, which meant I had to give up my management role,” she says. “I still love my job, and I love interacting with patients. I do come home exhausted, but it gives me a purpose.”
Hope for future patients
For Philippa, Dr Timm’s research offers hope – if not for her, then for future patients. “My lymphoma is currently stable, but I have been told I’ll need chemotherapy again within five years,” she says.
“I hoped that this research could help me next time around, but I think that realistically it will take longer for this research to reach patients. In future, there could be a drug that you could take alongside your chemotherapy.”
Philippa has always been against animal testing, but says her experiences have made her reconsider. “I know that Dr Timm’s research uses rats, and that chemotherapy is tested on animals too,” she says. “I do feel guilty about it, but I do want to live.
“I keep believing that one day I will be better, that I will wake up and feel normal again. It’s hard to accept that this may never be possible. I don’t want to give in. If anyone can be saved from going through all this, then we’ve got to do it.”