Heart disease and cancer are the top two leading causes of death in the U. S. and treating one can sometimes aggravate the other.
While advances in cancer therapy have significantly increased survival rates for many types of cancer, chemotherapy, radiation therapy and newer targeted therapies can have adverse effects on the cardiovascular system that range from mild conditions like hypertension to heart failure, myocardial infarction and arrhythmias. For cancer patients, especially those with pre-existing cardiovascular conditions, these complications can be life-threatening and may lead to interruptions in cancer treatment.
Now, an evolving field of practice has emerged that focuses on the interplay of cardiology and oncology: cardio-oncology.
“This is a relatively new field of cardiology that emerged about five to eight years ago,” said Dr. Vikranth Gongidi, of Premier Cardiology. “Basically, this is coming from years of experience. We’ve noticed that cancer patients are getting different chemotherapies and we found that some of those treatments were causing cardiac side effects and toxicity. So, by addressing one issue, like killing the cancer cells, treatments were harming other things, including the heart.
“One of the first recognitions of this was a medicine called doxorubicin that was used for breast cancer. Patients getting treated for breast cancer showed signs of cardiomyopathy or something that stops functioning properly and they ended up having congestive heart failure.
“Once that was identified, oncologists knew they had to figure out what doses were accurate for each patient based on their weight, frequency and development of the cancer. Over the last eight to 10 years there’s been a big explosion in oncology and how cancer patients are treated. We have chemotherapies that can actually cause regression and sometimes cure cancer, but then we’re finding that five or 10 years down the road, these patients have a higher incidence of heart disease.”
These side effects led to the growth of cardio-oncology, a subspecialty that identifies, monitors and treats cardiovascular diseases caused by cancer therapies. The goal is to reduce the side effects of cancer treatment on the cardiovascular system.
Cardio-oncologists are medical doctors who are specialists in their fields of cardiology or oncology and have received additional training to learn how to check and control cardiovascular risk before, during and after cancer treatment. They help decide which chemotherapies are safe for a patient’s heart and have the technology and expertise to monitor the heart muscle and heart valves during and after your cancer treatment.
“If a patient is diagnosed with cancer, our goal is to get them through that therapy safely,” Dr. Gongidi said. “Our goal is not to stop anything, because we want them cured of cancer, if possible. At the same time, we want them to have a good quality of life after the treatments.
“That’s where the partnership between the patient, the oncologist and the cardiologist begins. Together, we have to figure out which drugs will be best for the patient based on their risk factors and we need to closely monitor the patient during the treatment. The European Society of Cardiology is one of the first societies to devise guidelines for managing these patients and I have developed a protocol for my patients based on their recommendations.”
Before starting cancer therapy, the cardio-oncologist assesses the patient’s cardiovascular risk factors such as hypertension, diabetes, smoking and heart conditions. Blood may be drawn and often an echocardiogram or ultrasound is administered to detect any underlying issues. This comprehensive exam provides a baseline to follow as the cancer treatment progresses.
Throughout the cancer treatment, cardio-oncologists monitor patients closely for signs of cardiovascular toxicity. They may perform regular imaging tests, such as echocardiograms or cardiac MRIs to detect any changes in heart function early on.
If a cardiovascular complication arises during cancer treatment, the cardio-oncologist collaborates with the oncology team to manage these issues. This may involve adjusting the cancer treatment regimen, prescribing medications to support heart function or recommending lifestyle changes.
“I had a young patient who was undergoing chemotherapy for cancer, and I had been monitoring her for the past two years. We did ultrasounds every two to three months.
There was one episode where her heart function changed a bit, so I called her oncologist and suggested we extend the chemotherapy from every four weeks to every six weeks. We discussed the revised treatment schedule based on updated data from the ultrasound and proceeded with treatment. That close monitoring between her oncologist and cardiologist potentially averted any complications.”
Even after the cancer treatment ends, the cardio-oncologist continues to follow up with patients to monitor their cardiovascular health. Cancer survivors are at an increased risk of developing heart disease later in life, making long-term surveillance essential for early detection and intervention.
“I monitor some patients every three to four months after they’ve completed their therapy,” Dr. Gongidi said. “The effects of therapy on the heart can linger, with complications happening up to five years later. The biggest risk is usually during the first year after you finish your therapy and the risk goes down with time, but it never goes down to zero.
“If you’ve had radiation therapy on your chest, you have a higher risk of heart attacks because the radiation accelerates atherosclerosis that can cause blockages in the heart.
Those patients need to be monitored a least twice a year to make sure they aren’t developing any heart blockages.”
By bridging the gap between two disciplines, cardio-oncologists strive to improve cancer survivorship and provide a healthier quality of life for cancer patients. Patients diagnosed with cancer now have the option of consulting with a cardio-oncologist prior to treatment to reduce the risk of cardiac complications.
Dr. Gongidi recently opened Premier Cardiology, a concierge/hybrid practice where members can choose between having direct 24-hour access to him, or seeing his skilled nurse practitioner, under his supervision, on a fee basis covered by insurance.
Dr. Vikranth Gongidi is a graduate of the University of North Carolina, Chapel Hill, and he completed his internal medicine internship and residency at Botsford Hospital in Farmington Hill, Michigan. His cardiology fellowship was completed at the University of Medicine and Dentistry of New Jersey in Stratford. His office is at 787 37th St. Suite 250, Vero Beach. You can call 772-494-0794 or go to premiercardiologyvb.com for more information.