Managing the impact of cancer treatment on the heart
What is cardio-oncology
Cardio-oncology is a service that delivers cardiac care to patients undergoing or with a history of receiving potentially cardio-toxic cancer treatments. Depending on where your patient is in their treatment, we work in partnership with the referring physician to ensure that treatment is completed without interruption. For patients who have completed treatment, we work with their general practitioner to ensure a long-term cardiovascular risk reduction plan is in place to maximise long term heart health for our patients.
Why are cardio-oncology clinics required to support cancer patients?
Significant emerging evidence has shown that cancer patients are at an increased risk of experiencing heart disease.1 This is due to a combination of treatment risk factors and shared risk factors between many common cancers and heart disease. By monitoring their heart during treatment and beyond, our team can identify those who do experience changes in heart function. Early identification has been shown to lead to the best outcomes for the patient.2 Monitoring heart health during potentially cardio-toxic treatments helps patients remain on their required treatment with no interruption. The goal of cardio-oncology is to anticipate issues related to cardiotoxicity and develop targeted prevention strategies in cancer patients.
Read real life patient case studies here.
What do they involve?
Patients attending a GenesisCare cardio-oncology clinic will often attend for two separate appointments. The initial appointment will be with one of our senior cardiac imaging technicians for a baseline echocardiogram. This will assess left ventricular function but also use advanced imaging techniques to assess global longitudinal strain. Depending on the results and the referral your patient will then see one of a cardiologists who has a special interest in the field of cardio-oncology.
Oncologist/haematologist/radiation oncologist/ GP provides referral to cardio-oncology
Imaging technician conducts initial testing, such as an echocardiogram
Specialist cardiologist will assess results and current cardiac health, discuss the impact of cancer treatments on the heart, plan for long term cardiac monitoring and support and report back to the treating team
Who to refer?
All patients who have had or are currently undergoing cancer treatments that are potentially cardiotoxic should have a heart health check through our cardio-oncology clinics.
All patients undergoing or who have undergone thoracic irradiation (with exposure of the heart to ionising radiation) that have reasonable life expectancy should be considered for referral to a GenesisCare cardio-oncology service.
Special interest in cardio-oncology, coronary intervention, transcatheter aortic valve therapies, complex PCI and pharmacotherapy regimens for ACS and atrial fibrillation.
Special clinical interests in cardio-oncology, general cardiology, cardiac risk assessment, breathlessness and pulmonary hypertension, heart failure and valvular heart disease.
Special clinical interests in cardio-oncology, non invasive cardiac imaging , management of heart failure, valvular heart disease, hypertrophic cardiomyopathy and peri-operative medicine.
In 2017 Daniel became the Chief Medical Officer – Cardiology at GenesisCare. Daniel has developed an active interest in the field of cardio-oncology, the cardiac care of patients undergoing, and after, cancer treatment.
Special clinical interest in cardiac imaging, cardio-oncology, preventative cardiology, sports cardiology, lifestyle and dietary management of cardiovascular disease.
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References
Stoltzfus KC, Zhang Y, Sturgeon K, et al. Fatal heart disease among cancer patients. Nat Commun. 2020;11(1):2011. Published 2020 Apr 24. doi:10.1038/s41467-020-15639-5
Curigliano et al. Management of cardiac disease in cancer patients throughout oncological treatments:ESMO consensus recommendations Ann Oncol 2020; 31(2): 171-190
Swain, S.M., F.S. Whaley, and M.S. Ewer, Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer, 2003. 97(11): p. 2869–79.
. Barish, R., E. Gates, and A. Barac, Trastuzumab-Induced Cardiomyopathy. Cardiol Clin, 2019. 37(4): p. 407–418.
Mehta, L.S., et al., Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation, 2018. 137(8): p. e30-e66.
. Basaria, S., Cardiovascular disease associated with androgen-deprivation therapy: time to give it due respect. J Clin Oncol, 2015. 33(11): p. 1232–4.
Chen MH, Kerkela R, Force T Mechanisms of Cardiac Dysfunction Associated With Tyrosine Kinase Inhibitor Cancer Therapeutics Circulation. 2008;118:84–95
