Have you ever heard the term cardio-oncology? It’s quite possible that the answer is no. As an emerging medical specialty focused on cardiac complications arising from cancer treatment, this term has only recently gained widespread recognition. The medical community is constantly changing, adapting and building bridges from one specialty to another to provide the most individualized care for patients. Cardio-oncology is the perfect example of this.
Over the past few decades, research has advanced cancer treatment by leaps and bounds. More lives are being saved every day due to innovative and new treatment options. However, just as radiation and chemotherapy treatments can damage and kill cancer cells, they can also damage other parts of the body, including the heart. Dr. Rupal O’Quinn, a cardiologist at Penn’s Heart and Vascular Center specializing in cardio-oncology, answers our questions on this emerging field and its place at Penn Medicine.
Questions and Answers
What is cardio-oncology?
Cardio-oncology focuses on patients who have had or are currently undergoing cancer treatment. As a result of their past or present cancer treatment – whether it be chemotherapy, radiation or some of the newer, more targeted cancer agents – these patients’ hearts can be damaged and lead to some form of cardiovascular disease. In addition, many of these patients have baseline cardiovascular disease that is exacerbated by the therapy or cancer itself. Cardio-oncologists also work closely with oncologists to protect and monitor the patient's heart both during and after treatment to ensure that the patient has the best chance of fighting cancer while minimizing potential cardiac damage.
Who is at risk?
With the most obvious risk being certain past or current cancer treatment that is known to be cardiotoxic, patients who already have risk factors for developing heart disease – high cholesterol, high blood pressure, tobacco use, diabetes, obesity or family history – have an increased chance of its development during treatment.
If patients are being treated with radiation, especially to the chest, they are at risk for developing multiple types of cardiotoxicity that can affect the different parts of the heart, including the actual muscle, circulation system, conduction system or valves. Due to research, we now know ways to minimize radiation exposure to vulnerable parts of the heart. Unfortunately, there are patients who received radiation treatment decades ago when the harmful effects of the exposure was unknown and are just now experiencing the aftereffects on their heart.
What if I had radiation or chemotherapy years ago and develop heart disease?
Since survival rates from many cancers were so low for so long, we are only beginning to learn about the cardiotoxic effects of cancer therapy, as people are living longer and the number of cancer survivors is increasing every year. We are also learning that the additive effects of radiation and chemotherapy not only help treat cancer better, but can have more of a toxic effect on the heart. Many cancer survivors are completely asymptomatic, or may already be manifesting cardiac side effects from their therapy. It is recommended that survivors pay attention to their cardiac risk factors and speak to their primary doctor or oncologist about a referral if there is any concern about their cardiovascular health. The benefit of being a part of a system that has cardiologists that specialize in cardio-oncology is that we recognize the potential forms of heart disease people are at risk of depending on which therapy they received. We work closely with the Survivorship Clinic, which also ensures that cancer survivors are up-to-date in their screening for potential complications to other organ systems from their cancer and/or therapy.
What are the symptoms?
Some of the symptoms of heart complications as a result of cancer treatment are consistent with the typical indicators of heart disease. If a patient is undergoing chemotherapy or radiation, we should be even more cautious of symptoms such as:
- Chest pain or discomfort
- Shortness of breath
- Feeling of dizziness or lightheadedness
- Racing or pounding heart
- Swelling of the legs and/or feet
- Signs of a heart attack
- Difficulty lying flat
How is it treated?
Depending of the depth of the cardiac complications and damage to the heart, patients who develop cardiovascular disease due to cancer treatment can be treated with anything from medications to a heart transplant. We know that certain medications can make your heart muscle stronger if it has been weakened by cancer therapy. Other people experience side effects that can cause cardiac ailments that others in the general population experience, and are treated similarly, such as certain arrhythmias, or blockages in the heart arteries. If fluid builds up around your heart due to the cancer or its therapy, it can be removed and then monitored for accumulation. In all instances, we look at the individual situation and work with the oncologist to determine the best solution while ensuring that the patient continues to receive the most appropriate cancer treatment if they are in the midst of therapy.
Learn more about the Penn Heart and Vascular Center