Cardio-oncology is a new specialty of cardiologists and oncologists who partner to combine their knowledge to help protect the hearts of patients undergoing cancer treatment. While cancer treatments have improved, many leading therapies place the heart at risk of damage. Additionally, many cancer patients have preexisting heart disease that could be exacerbated by cancer treatment.
“Three years ago I came across some literature on cardio-oncology, and thought, 'Gee whiz, this is going to be an important field,’” said Hess, reflecting on when he began treating patients at Massey for cardiovascular complications. He was considering retiring from the field of heart transplantation when he treated his first oncology patient. Now three years later, cardio-oncology has become the fastest growing discipline in the field of cardiovascular medicine, and Hess’ program runs a full-time outpatient clinic and inpatient service, with 1,200 outpatient appointments and 500 hospitalized patients per year from across the state and beyond.
Hess works closely with a team of 25 Massey oncologists and bone marrow transplant specialists in the Cardio-Oncology Program, but he and Emily Hulburt Baker, R.N., are currently the only cardiology staff dedicated to cancer patients. The clinic provides three main services. First, it works to provide preventative care by screening patients before they undergo oncology treatment. Next, it provides treatment to patients who develop heart issues in the course of being treated for cancer or whose pre-existing heart disease needs to be managed during the course of cancer treatment. Finally, when patients conclude cancer treatments the program helps them maintain good health.
“Today, more people are surviving cancer than ever before thanks to newer and better forms of treatments,” says Hess, who is a cancer survivor himself. “But some of these treatments can cause lasting damage to the heart, especially if the patient was already at risk for heart disease.”
Different cancer treatments pose different risks. For example, anthracyclines, such as doxorubicin and idarubicin, are common chemotherapy drugs given for the treatment of many cancers, including breast cancer, leukemia and lymphoma. Anthracyclines can cause cardiomyopathy, or weakening of the heart muscles, which can lead to congestive heart failure. Patients who undergo bone marrow or stem cell transplantation are often exposed to large doses of these drugs in order to prepare their bodies for transplantation. Other chemotherapies and cancer medications such as targeted agents and hormone therapies can have cardiac toxicity as well.
Radiation therapy can also cause unintentional damage to heart tissue. This is especially true for tumors around the chest, such as breast and lung cancers.
There are very little standard protocols when it comes to caring for cardiology complications as a result of these treatments, so Hess’ program works to define these guidelines through evidence-based research.
To help maintain heart health, Hess advises six general lifestyle modifications to cancer patients and survivors, and they apply to everyone, including those without a cancer diagnosis, as well:
- Cut out cigarettes and tobacco products- Abstain from alcohol - Maintain a healthy weight to prevent type 2 diabetes - Monitor cholesterol Maintain healthy blood pressure - Exercise daily, if possible
Some patients experience enough damage to their heart that they should limit or avoid exercise. Patients are advised to discuss these potential limits with their oncologist and cardiologist.
“Targeted therapies are revolutionizing cancer treatment, but we do not yet have all the data on how these new treatments impact the heart,” says Hess. “The field of targeted therapies is going to be a major area of focus in cardio-oncology research moving forward.”
Hess is looking to add more cardiologists to the program in order to meet the increased patient demand for cardio-oncology services and to continue conducting much-needed research to establish new standards of care. Hess hopes the program continues to grow and contribute to better long-term outcomes for patients at VCU Massey Cancer Center.
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