Cancer & The Heart: Bring on the Cardio-Oncologist

Cancer & The Heart: Bring on the Cardio-Oncologist
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For someone facing a diagnosis of cancer, worrying about heart health may not seem like an immediate priority. Ever since the introduction of chemotherapy, however, doctors have known certain cancer treatments can cause cardiac issues. 

“You can’t take good care of a cancer patient without taking good care of their heart,” says Doug Flora, M.D., medical oncologist and executive medical director of oncology services at St. Elizabeth Healthcare. 

While more people than ever are beating cancer, Flora points out, heart disease is the second leading cause of death among cancer survivors, sometimes partially caused by the cancer treatment. 

That’s why St. Elizabeth has aggressively committed to the evolving and growing field of cardio-oncology, focusing on the treatment of heart problems that develop during the treatment of cancer and can linger for years after cancer is in remission. 

St. Elizabeth has established a cardio-oncology clinic under the direction of newly hired cardiologist Darek Sanford, M.D., who recently completed a cardiology fellowship with extended training on the impact of cancer on the heart.

In the past, the oncology profession has dealt with heart issues “somewhat ad hoc,” according to Flora. Now the approach at St. Elizabeth is to identify patients at cardiac risk from the beginning of a cancer diagnosis. 

“Dr. Sanford and his team are using new technology and techniques for better risk stratification and to intervene at an earlier setting,” Flora says. “That goes along with everything we are trying to do at our cancer center – to build a formal, holistic, patient-centered care plan addressing all the quality of life issues.” 

“Previous methodology was somewhat reactive,” Sanford adds.  “Sometimes when a problem developed, a cardiologist would review things and put the chemotherapy on hold. The new paradigm is more proactive where we are trying to find subtler things, like laboratory markers, before patients get to a severe level where they are symptomatic and have large changes in their heart muscle. The cancer therapy doesn’t necessarily have to be stopped. We can use beta blockers and other medication. We start early and can be aggressive with the patients to get their therapy both with the cancer and the heart muscle.”  

Obviously, those with pre-existing heart issues going into cancer care face a higher risk. Sanford says it is not so much the types of cancer that are linked to heart issues, but the types of treatments.

“Chemo and radiation can have effects on the heart as can some of the newer inhibitor drugs and targeted therapies. As some of the newer drugs come out, we are finding they have an impact. It is a developing, evolving field. The ultimate goal is to maximize the ability for the oncologist to treat the cancer while minimizing the effect on the heart,” Sanford says. 

Sanford emphasizes that cardiac issues and cancer treatment must be treated case by case. “There are certainly people who don’t have any cardiac problems, but do develop issues with treatment of cancer.” 

While Sanford’s clinic is seeing patients now, its ability to provide personalized, collaborative care will be greatly increased when the new $130 million St. Elizabeth Cancer Center opens on 136 acres of its Edgewood campus next August. 

“We will have the advantage of having a cancer center where the cardiologist is physically near the oncologist, allowing for direct communication,” Flora says. “There are 15 million cancer survivors in the country. Many are left with a reduced quality of life because of the cancer-fighting drugs. Doing this kind of heart care prevention is critical. We can’t underestimate the impact on survivorship by eliminating, reducing or preventing the damage that can occur to the heart.” 

For more information, visit stelizabeth.com/heart.

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