Cardio-oncology at Doylestown Health: Protecting the heart health of cancer patients

Providers from the Cancer Institute at Doylestown Health (DH) and the Woodall Center for Heart and Vascular Care recognized the need for guidelines to identify people at risk for cardiac complications related to cancer treatment. Joining forces in 2020, the two institutions formed a multidisciplinary team that reviewed the latest studies and patient experiences and developed evidence-based guidelines for a new Cardio-Oncology Program dedicated to managing the heart health of cancer patients.

The Cardio-Oncology Program stands out as one of the few in the region and currently oversees the care of 450 patients. With a robust team comprising cardiology, breast surgery, oncology, radiation oncology, and more, the program provides comprehensive support to survivors with diverse diagnoses.

About cardio-oncology

Cardio-oncology is an emerging specialty focused on identifying patients at risk for cardiotoxicity as a result of cancer treatment and providing access to early cardiovascular assessment and intervention.

“Today, we can access effective medications that can treat various cancers. However, these treatments may also increase the risk of heart problems,” observes cardio-oncologist Lawrence T. Bish, MD, PhD.

Well-positioned to provide comprehensive services to safeguard heart health, PMDH is home to a Heart and Vascular Center that offers nationally recognized care, from preventive measures to interventional cardiology and complex surgical procedures.

Coordinated, personalized cardio-oncology care

Kassie Richman, RN, BSN, a dedicated cardio-oncology nurse navigator, is the primary contact for referring physicians and patients, bridging the gap between the oncology and cardiology departments.

“The Doylestown Health Cardio-Oncology Program receives referrals from oncologists, surgeons, primary care physicians, and other cancer nurse navigators,” says Kassie, who answers questions and coordinates specialty care and the transfer of patient records. She reviews test results and educates patients about potential risks and what to expect during cardiology appointments.

Mission statement

The mission of the DH Cardio-Oncology Program is to improve the cardiovascular health of patients with cancer and cancer survivors through education, training, research development, and interdisciplinary collaboration with the object of minimizing cardiovascular and cardiometabolic toxicity during cancer treatment and attenuating cardiovascular risk during cancer survivorship.

Which patients benefit from cardio-oncology

Cardio-oncology patients fall into three categories:

• Those who have pre-existing cardiovascular disease, or those who do not have cardiovascular disease but are at cardiovascular risk either because they are receiving potentially cardiotoxic chemotherapy or radiation to the head, neck, or chest, or they have risk factors like family history, hypertension, diabetes, or high cholesterol
• People who are undergoing treatment and develop cardiac or vascular symptoms, like shortness of breath, chest pain, or changes in their EKGs
• Survivors who had chemotherapy 10 or 20 years ago, when the long-term side effects and toxicities of chemotherapy and radiation therapy were not widely understood, and have accelerated cardiovascular-related issues or may be at risk

“We also see patients who have primary cardiac tumors which can disrupt heart function,” says Dr. Bish. “As these tumors must be removed, our cardio-oncologists work closely with Doylestown Health’s highly skilled cardiothoracic surgeons to coordinate care.”

Assessing cardiac risk before treatment

Dr. Bish notes that while there are many effective medications to treat various cancers, some may increase the risk of heart problems, even years after treatment.

Thus, in an effort to protect the heart during and after cancer treatment, DH cardiologists perform an echocardiogram prior to cancer therapy to identify a patient’s baseline. Patients are then followed to target modifiable risk factors to help prevent more severe health complications.

“For patients with pre-existing heart disease, we are aggressive about medical management with cardioprotective therapies, to reduce the risk that a patient’s heart may worsen with cancer treatment,” Dr. Bish explains.

Monitoring patients throughout cancer therapy

A patient’s heart function is evaluated and monitored throughout cancer treatment using serial echocardiograms. If a cardiac issue develops, DH cardio-oncologists use evidence-based therapies to help preserve and improve cardiac health, allowing patients to continue chemotherapy without interruption.

According to Dr. Bish, this process also involves measuring ejection fraction and cardiac strain, which can help predict the risk of chemotherapy-related side effects, such as cardiomyopathy.

Cardio-oncology in Survivorship

“On the survivorship side, we follow patients regularly with echocardiograms, stress tests, and carotid ultrasounds,” says Dr. Bish.

Extensive radiation therapy to the head, neck, and chest is identified with increased risk of carotid, coronary, and valvular heart disease, but has decreased over time with innovation. Today, in partnership with Penn Medicine Radiation Oncology, Doylestown Health offers cardio-protective radiation treatment modalities such as breath-hold and prone radiation.

Access to resources

The Cancer Institute DH is at the forefront of community-based hospitals providing cancer care in Philadelphia’s northern suburbs. In addition to cardio-oncology, patients can access cancer rehabilitation, support groups, integrative medicine, and education about healthy lifestyle options, nutrition, and smoking cessation.

Survivorship program

The Survivorship Program addresses the physical and emotional needs of patients transitioning from active cancer treatment to survivorship. Patients work with a survivorship specialist who monitors health progress and milestones, ensuring a comprehensive approach to care throughout the cancer journey.

Cancer rehabilitation, PORi-certified

Recently named among the inaugural recipients of the Physiological Oncology Rehabilitation Institute’s Centers of Excellence (PORi), Doylestown Health’s Cancer Rehabilitation Program helps patients reduce the impact of side effects to improve their quality of life.

Cancer risk and genetics program

Cancer risk and genetics services help patients obtain information about their cancer risk, allowing us to provide early detection and prevention of cancer in patients and at-risk family members.

About Penn Medicine Doylestown Health’s Heart & Vascular services

Expert cardiologists and cardiac surgeons assist patients and physicians with managing risk factors for heart disease, offer advanced treatment options, and provide outstanding emergency cardiac care. Doylestown Health's accredited Chest Pain Center is fully prepared to treat cardiac emergencies around the clock, focusing on rapid diagnosis and effective treatment. The multidisciplinary team at the Woodall Center for Heart and Vascular Care is dedicated to providing the highest level of quality care and patient safety.

About the Doylestown Health Cancer Institute

The Doylestown Health Cancer Institute offers patients the quality care they expect from a leader in cancer diagnosis and treatment. Accredited by the American College of Surgeons Commission on Cancer, DH board-certified physicians and oncology-certified practitioners provide comprehensive, coordinated care and services for the full range of cancer diagnoses, including breast, lung, urologic, gastrointestinal, and other cancers.

Clinical consult and patient referral

To refer a patient for cardio-oncology care at Doylestown Health, please call 877-937-7366, or refer a patient online.