This article is written by Dr. Darek Sanford, a Cardiologist and Cardio-Oncologist with St. Elizabeth Physicians. He sees patients in Fort Thomas and Edgewood, Kentucky.
Q: What does a cardio-oncologist do? When should people seek help from one?
A: Physicians trained in cardio-oncology see cancer patients and survivors who develop or are at risk of developing side effects that affect the heart. The cardio-oncology referral pattern falls into three areas.
At the initial cancer diagnosis some patients, based on co-morbidities and treatment plans, benefit from having a cardiovascular evaluation. These evaluations can assess and reduce the risk of cardiac events.
Second, patients undergoing cancer treatment may develop symptoms that are heart related in nature during or due to cancer treatment. These patients should also be referred to a cardio-oncology specialist. Referrals for these first two patient types are typically triggered by an oncologist.
Finally, the third type of referral either happens after cancer treatment is complete or if the patient is in remission. When we work with these patients, we consider the development of a survivorship plan to monitor for any evidence of emerging heart disease. Any provider or patient can ask for this type of referral.
Q: What’s something surprising about your specialty that people might not know?
A: Cancer appears to be an independent risk factor for the development of cardiovascular disease. This is important as the current strategies targeting earlier disease detection, as well as improving treatment plans, lead to more patients with extended remission. For many types of cancer, once remission has been achieved, cardiovascular disease quickly becomes the leading cause of death rather than cancer recurrence.
Q: What is St. Elizabeth doing in this field that is innovative, unique or leading edge?
[H2] A: The current focus of the cardio-oncology program at St. Elizabeth is identifying and treating patients at high risk of developing heart failure during cancer therapy. Those who are most impacted by this are patients undergoing treatment or surviving breast cancer.
Developing pathways for early referral has led to patients starting medications that can protect the heart during cancer treatment. For patients at lower risk who don’t benefit from upfront medication treatment, we follow them with regular lab work and echocardiograms — an ultrasound of the heart — to monitor for a change in their risk for heart failure. If we see those changes, we evaluate further and provide treatment.
Q: What is currently on the horizon for cardio-oncology? What changes might we expect in the next few years?
A: As cancer treatment evolves, so will the need for cardiology involvement in cancer care. Targeted therapies, such as tyrosine kinase inhibitors, as well as immune checkpoint inhibitors, have expanding roles in cancer treatment. Both of these therapy classes have notable cardiac side effects. Further research is underway to identify the best time to start cardiac medications, as well as the best modalities and frequency of monitoring heart function during chemotherapy.
Q: Does St. Elizabeth offer screenings for early detection of illness in cardio-oncology?
A: Two markers are used for early detection of cardiac involvement in cancers that are found in blood work. Troponin is commonly used to detect heart attacks in the emergency department. NT Pro Level evaluates any cardiac causes of shortness of breath and monitors heart failure patients.
These blood tests are conducted before patients start cancer treatment and at certain intervals during treatment. They serve as an early warning of cardiac involvement. Along with blood work, an echocardiogram is done frequently during some chemotherapy regimens to ensure it’s safe for patients to continue medication. The goal is to allow patients to complete cancer treatment without interruption and with the lowest long-term risk to the heart.
Q: From your perspective as a cardio-oncologist, what should people be aware of to prevent disease or catch it early?
A: The patients who are at the highest risk for future cardiac events already have identified cardiac conditions that appear with a cancer treatment plan that includes chest radiation and drug classes HER2 receptor inhibitors or anthracycline.
St. Elizabeth is doing an excellent job of monitoring these patients from cancer diagnosis through treatment. Patients need to be aware of the long-term cardiac implications of cancer and its treatment. Even if they have achieved remission, they should be evaluated for even small cardiac complaints, such as swelling, shortness of breath, palpitations, and chest pain, even if those symptoms appear years after cancer treatment.
Learn more about cardio-oncology services at St. Elizabeth.