Heart problems due to Chemotherapy - EF 37%

[OneStressedSon]

Hi all,

I have no other way to know but to post it here as I can not find much information on the internet either.

My father is stage iv suffering from leiomyosarcoma. He was on chemotherapy and as soon as he had 6th cycle started, infused and came out of the hospital, he felt shortness of breath. A little later, he was okay and drove the car 70 km to home. He then did not feel so good which was normal for us to know because after the chemo infusion, he usually wouldn't feel good for a week. But this time, he was having shortness of breath, went to the local doc who said infection, but he got worsen with shortness of breat the day before his visit to the oncologist for his 6B infusion of chemo.

He was having Gemzar/Taxotere. The next day he visited his oncologist who sent him for a test which showed his EF was 45%. He then referred him to the cardiologist who asked for a stress test. After 3 weeks, the results are as below:

Suggestive of fixed perfusion defects of mild to moderate degree involving mid anterior and mid to basal inferior segments of left ventricular myocardium.
Overall reduced ejection fraction, with dilated LV cavity alongwith transient dilatation (TID: 1.24) and global hypokinesia is suggestive of associated cardiomyopathy.
No significant reperfusion is noted in rest study. No other perfusion defect is noted in rest of the myocardial segments. Post-Stress EF: 27%, Rest EF: 37%

I am worried about his cancer treatment as it brought it to halt and the oncologist said he can not give him chemo unless EF reaches to at least 50%.

The chemo was working great for him, reducing his tumours almost half (including lungs and inguinal area) and we were happy that we might see a complete remission after another 6-7 cycles of chemotherapy.

I live thousands of miles away from my dad and I am constantly worried about him.

My questions: 1: Is it possible it reverse it, e.g. his EF reaches back to 50% sooner because we are worried about his cancer and he needs chemo?
2: How much time do you think it might take? And is it too much worry for him (and for us, of course)?
3: If you know about chemo breaks, then I need to know if the breaks are okay and the cancer will not affect much during the period he recovers?

I really don't know what else to ask but any additional input will be of great help. Thank you very much in advance for your input.

Regards,
A worried son who loves his father and mother more than anything in this world

[achillea]

What a difficult situation for you, and of course, for your parents!

Unfortunately, anti-cancer agents can cause cardiomyopathy with the lowered ejection fraction you've noted.  When that happens, the oncologists have no choice but to stop the chemo.  If the heart failure is noted early enough in the game, it can be possible for the heart to recover somewhat.

Each case is individual, and really, only your father's cardiologist can tell you if his heart will recover and how long it might take.  Likewise, only his oncologist can tell you whether or not the cancer will behave aggressively in the interval.

Since you live very far away, I think you have only two choices to help you get more information:

1.  Schedule an appointment with your father's doctor and fly home to discuss this in person.

2.  It might be complicated with privacy issues, but with the signing of certain documents, there should be some way for you to converse by phone or skype with your father's principle doctor.

I'm sorry you are having to deal with this.

[OneStressedSon]

Thank you so much for taking time to first reading the post and then replying to my post. I just came back 4 months ago visiting my father, staying for 50 days and get him on chemo, else he was shattered before I visited him. It is difficult for me to travel again at this time. Unfortunately, I can not even get the mean time of getting EF back to normal if it is above 35%. That would at least give me some insight but again, as you mentioned, it depends on individual how he/she responds.

All I can do is to pray that things get better and he is back on chemo soon!

Thank you once again for the reply!