Who are cardio oncologists?
Cardio oncologists is a new medical speciality that focuses on the optimal treatment of any cardiac conditions associated with patients who have been treated for cancer or are currently being treated for cancer. Cardio oncologists can evaluate patients for potential risks of developing certain heart diseases, especially if they are receiving certain types of cancer drugs or after radiation therapy to the chest.
A group of specialist cardiologists and cardio oncologists have special expertise in preventing and treating adverse effects of the heart from cancer and cancer treatment and can provide consultations on diagnostic testing, medical management, interventional and surgical procedures.
The University of Washington Cardiology and Oncology Center works closely with the Cancer Center to facilitate cancer treatment and reduce any potential cardiac toxicity associated with the ultimate goal of improving the survival and quality of life of our cancer patients.
What does cardio oncologists do?
Our Cardiology Oncology Program is led by trained cardio oncologists to evaluate and treat people who have heart disease or who may develop heart disease before, during, and after cancer treatment. Some malignant growth therapies, including radiation treatment and chemotherapy, can intensify or even reason heart issues.
Our cardio oncologists aim to:
- Advice and guidance for people with existing heart conditions or at risk of developing heart disease before starting cancer treatment
- Monitor people before and during cancer treatment to identify early any heart complications and any heart-toxic side effects from cancer treatments.
- Preventing or reducing further heart damage – and reversing its course if possible
- Screening for any heart complications after cancer treatment is complete
- Offer lifestyle changes to help reduce heart disease risk and maintain health
- Elimination of heart disease as a barrier to effective cancer treatment
- A better understanding of heart problems in cancer patients through participation in research studies
Our cardio oncologists work alongside oncologists to discuss patients’ heart functions and create a specialized treatment plan to prevent and reduce heart risks without interfering with cancer treatment.
Diagnostic cardiac tests recommended by cardio oncologists
In order to monitor your heart and determine the need for cardiac tumor treatment, there are several tests that may be evaluated while receiving cancer treatment. An echocardiogram is an ultrasound imaging of the heart. Measurements are made on images, and with each heartbeat, an estimated volume of blood pumped out of the heart can be calculated.
This estimated percentage is called the left ventricular ejection fraction (LVEF). It is known that several anti-cancer drugs can reduce LVEF. Your cardio oncologists may perform an echocardiogram at the start of treatment and periodically during and after treatment.
If there is a 10% decrease in percentage volume, you will likely be referred to a cardiac tumor care provider to determine if any medications could be helpful to protect your heart. Other tests, including simple or imaging blood tests, may also be performed during routine laboratory work and testing. Common laboratory tests recommended by cardio oncologists and imaging of the heart:
- BNP, NT-proBNP
- Cardiac MRI
- Lipid Profile
- Electrocardiography (EKG)
- Troponin I or T
- Echocardiography (Echo)
The cardio oncologists will monitor the results of these lab and imaging tests. If any results show a change in heart function, you may need to start taking the routine medications used to protect the heart. Often, once the cancer treatment is finished, the heart’s function may improve.
Therefore, the cardio oncologists will monitor your test results even after you have been treated, and ultimately, it may be possible to reduce or stop the dose of heart medications altogether. There are new techniques being developed in cardiac imaging, called stress imaging, that may be useful in the future. Heart preventive medications used to treat cancer
- Some beta-blockers, such as carvedilol, can improve heart rate control and reduce the resistance the heart has to overcome, thus helping to maintain heart muscle function. These are usually used in the general population for high blood pressure or congestive heart failure. There have been recent research studies showing that this drug may prevent the irreversible cardiac dysfunction associated with some anti-cancer drugs. Examples of these medications include carvedilol (Coreg) or nebivolol (Bystolic).
- ACE inhibitors are another class of drugs that have been shown to protect the heart during treatment with anti-cancer drugs. Examples include lisinopril or enalapril.
- Spironolactone may be used if LVEF (the left ventricular ejection fraction) decreases from the heart and begins to increase swelling in your legs or abdomen and increase shortness of breath.
About risk factors and cardiotoxicity explained by Cardio oncologist
Cancer survival has improved dramatically over the past 30 years with the introduction of new and effective cancer treatments. As a result, there is a significant increase in the number of cancer survivors. An increasing range of complex new treatments is allowing better comprehensive outcomes for patients being treated for cancer.
However, these treatments have toxicity, especially on the cardiovascular system. The good news is that providers are becoming increasingly aware of potential cardiac toxicities from various cancer treatments including arrhythmias, valvular heart disease, coronary artery disease, high blood pressure, and heart failure.