Matters of the Heart: Managing Cardiac Health in Cancer Survivorship

For Dr. Dawn Mussallem, the issue of heart health in cancer survivorship is deeply personal.

Mussallem, a longtime lifestyle medicine and integrative breast cancer specialist, is a cancer survivor as well as a recipient of bone marrow and heart transplants — and a mother and marathon runner.

In 2000, when she was 26 and in the early months of medical school, shortness of breath and fatigue were originally dismissed as asthma or maybe stress — until she 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.

Mussallem, a longtime staffer at the Robert and Monica Jacoby Center for Breast Health at the Mayo Clinic in Jacksonville, Florida, is now the chief medical officer of Fountain Life, a healthy longevity brand developing a next-generation preventive health model through advanced artificial intelligence (AI) diagnostics, restorative therapeutics and AI-driven health intelligence, according to a news release from the company.

“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. When it comes to cancer survivorship, heart health needs to be optimized, but it needs to be optimized among all individuals. We know that this is the No. 1 reason men and women die, and 90% [of cases] are totally preventable.”

“To Survive Cancer Only to Succumb to Heart Disease Is, I Think, a Crime”

Dr. Michelle Bloom, the System Director for the New York University Langone Health Cardio-Oncology program in New York City and clinical professor in the Department of Medicine, the Leon H. Charney Division of Cardiology at NYU Grossman School of Medicine, has made it her life’s work to recognize what she describes as a massive issue of overall cardiovascular disease in the cancer population.

“I think that the population of patients that has survived cancer is a very unique opportunity for us because It is such a blessing that they have survived cancer — and to survive cancer only to succumb to heart disease is a missed opportunity,” she says.

As treatments have evolved, more patients are surviving cancer than ever before, as the American Cancer Society recently revealed, noting in its 2026 annual report of statists that the five-year survival rate for all cancers combined is at an all-time high of 70%.

“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 Bloom. “We used to be very focused on ‘Can we cure the cancer?’ and now the conversation has evolved to ‘We can very likely have you survive a very long time either with or post-cancer, but how do we help you live well after cancer?’”

Bloom says that cardio-oncology providers see a wide-spectrum of connections between cancer treatments and heart health.

“You name it and we see it in a cardio-oncology clinic,” she says. “We care for survivors of childhood, adolescent, and young adult cancers who develop heart conditions at a much younger age than our typical patients. Survivors of cancer can develop heart failure, where the heart muscle becomes weakened or stiffened. We see valvular disease, in which the heart valves can become narrowed or leaky, as well as coronary artery disease – blockages of the arteries of the heart – especially in patients that have received radiation to their chest as part of their cancer treatment.We also treat conditions like constrictive pericarditis, where the sac surrounding the heart becomes thickened or stiff, leading to symptoms like shortness of breath and chest pain. These are just a few of the many cardiovascular problems we see that are directly or indirectly related to cancer therapies patients received earlier in life.”

“When we step back, my cancer was diagnosed in 2000. This was a long time ago,” Mussallem says. “This was before we really had total clarity on the impact of these aggressive treatments on heart health. And in my situation, I had a Stage 4 cancer; it was like a Hail Mary. We really didn't know if I would survive this cancer, and they knew that the only chance for a meaningful recovery was to do this very aggressive bone marrow transplant.

“So that's what we did. We did high-dose chemotherapy with something called CHOP [cyclophosphamide, doxorubicin, vincristine and prednisone] chemotherapy, where I got high doses of Adriamycin with that, and I had that for several cycles — four cycles total — and then after that, I went on to dose-dense chemotherapy as my induction for my bone marrow transplant, with more Adriamycin as well as other chemotherapies, also toxic to my heart. I had the bone marrow transplant, and then that was followed by two months of radiation, and my tumor was actually wrapped around my heart, so the radiation had to go to the heart.”

A Cancer Diagnosis One Day, Heart Failure the Next

Samantha Edall was diagnosed with heart failure in 2023, the day after she, at the age of 34 and as the mother of a 6-month-old daughter, received a diagnosis of breast cancer.

Her heart failure was brought on, according to an article posted to Virginia Commonwealth University (VCU)’s website, by her pregnancy and the stress placed on her body from cesarean section complications and an extended hospital stay.

A patient of the cardio-oncology program at the VCU Health Pauley Heart Center, Edall had her heart health regularly monitored and was medicated throughout a cancer treatment journey that included 20 rounds of chemotherapy, a double mastectomy with reconstruction and 33 rounds of radiation.

“I still see that same cardio-oncologist, and he makes sure that my heart is OK now, because I'm on aromatase inhibitors and other things that are really hard on the heart,” Edall says. “But since I really started medication, my heart did a massive rebound, and it's been good since. So, fingers crossed that I've got a lifetime of that, but my cardiologist feels pretty good about it.”

What Can Patients and Survivors Do About Their Heart Health?

Dr. Eric Yang, founder and director of the UCLA Cardio-Oncology Program, tells CURE that provider attitudes are changing regarding physical activity during cancer treatment.

“Historically speaking, patients were basically told, ‘You have cancer; you’re getting chemotherapy that will make you sick, just eat whatever you want. Take it easy on yourself. Don't do much.’ And obviously there are people with advanced, end stage cancer where this may apply, but attitudes have shifted where more and more of the cardio-oncology community, are instructing patients with cancer that have favorable prognoses to try to have as much normalcy in their daily routine; this may may make them more fit and stronger for ongoing treatments, and also may be beneficial for their heart health down the line.”

Yang notes that a recent publication in The New England Journal of Medicine in 2025, the CHALLENGE trial, generated a lot of attention in both cancer and cardio-oncology circles. It demonstrated that in patients with stage 2 to 3 colon cancer, a structured exercise program after surgery and postsurgical chemotherapy was associated with a reduced risk of cancer free survival. What was particularly interesting was that there was a signal of improved survival in the patients who underwent this exercise intervention.

“That's just one example of how we should really be framing that physical activity may be beneficial in many ways, not just for a possible better quality of life — but it actually may lead to better outcomes related to heart health, and how they fare overall on their cancer journey,” says Yang.

“We'll take breast cancer survivors, for example,” says Dr. Jennifer Liu, the chief of cardiology at Memorial Sloan Kettering Cancer Center in New York City. “We know from epidemiological studies that breast cancer survivors are at higher risk of heart failure and cardiovascular disease. And what we also know is that in this group, if individuals have conventional cardiovascular risk factors, such as obesity, hypertension, diabetes, they are at even higher risk.

“So an actionable step for survivors, and one that is evenmore important for this group than for the general population, is to minimize their cardiovascular risk factors: making sure they seetheir doctors regularly, that their blood pressure is optimized and their cholesterol is well controlled, that they exercise and of course, that they avoid smoking and other potential risk factors that could further elevate their risk.”

Edall — who maintains an active lifestyle on a farm and as the parent of a toddler — is now living with her cancer in remission, and she is no longer in heart failure, though some of the medications she takes to reduce her likelihood of cancer recurrence may have long-term heart health impacts.

The Work Continues

Edall is enrolled in the CROWN Study, a VCU clinical trial tracking heart health in women following a diagnosis of breast cancer.

“Monitoring your heart and seeing if you can get in with a cardiologist, I think, is a huge benefit, because obviously cancer treatment is just so hard on the heart, especially for breast cancer,” Edall says. “Everything that you go on during treatment and then following treatment is so difficult. And I think even if I hadn't had the heart issues, I'm so grateful that my heart has been tracked. … As much as it's stressful every single time waiting for those results, just being able to know that my heart health is OK during treatment and afterwards is huge.”

Meanwhile, City of Hope in Duarte, California, has opened a phase 2 clinical trial that is designed to address the increased cardiovascular and metabolic risk associated with androgen deprivation therapy among patients with prostate cancer.

Liu will serve as the director of the 2026 MSK Cardio-Oncology Symposium, held May 21 to 22 at the Mortimer B. Zuckerman Research Center in New York City, an event now in its seventh year, with a faculty roster this year that includes Yang.

“The faculty will consist of cardiologists and oncologists, covering a wide range of topics, including cardiovascular care before, during and after cancer treatment, as well as risk stratification, surveillance and management.We will also present cutting-edge innovations and breakthrough research currently underway,” Liu says of the event. “We've been quite successful over the past six years, and the primary goal is to bring clinicians together and educate them on best practices in caring for patients with cancer.”

One year after receiving a heart transplant, Mussallem ran the 2022 National Marathon to Finish Breast Cancer, operated by the DONNA Foundation.

“We've learned from cases like mine,” Mussallem says. “Wait a minute. We've got to be more mindful, in these young humans we’re trying to cure of the cancer, of the collateral damage along the way and what sort of things can help to stand to protect individuals in my situation that require these higher doses of chemo, require radiation more near the heart fields, and we've come so far because of individuals like me.”

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