The University of Michigan Samuel and Jean Frankel Cardiovascular Center, working with specialists at the University of Michigan (U-M) Comprehensive Cancer Center, has launched Michigan’s first cardio-oncology clinic, a program designed to prevent or minimize heart damage caused by chemotherapy and radiation.
Preventing heart disease in cancer patients is gaining more importance as aggressive cancer therapies are used on older patients who may already have heart disease, and researchers identify a growing number of cardiovascular side effects of anti-cancer therapy.
Eliminating Cardiovascular Complications a Key Goal
“The goal of the collaboration between cardiologists and oncologists is to eliminate cardiovascular complications as a barrier to effective treatment of cancer patients, by providing prevention and early detection of cardiac complications, cardiovascular monitoring during anticancer therapy, and therapy of cardiovascular disease that develops during chemotherapy,” says University of Michigan cardiologist Elina Yamada, MD.
Physicians will use strain imaging with echocardiograms to help detect heart damage in its earliest stages before heart function deteriorates.
Radiation to the chest, especially among patients with left-sided breast cancer, leukemia and chest tumors, can lead to inflammation of the heart’s protective sac, the pericardium, or narrowing and stiffening of heart valves.
Current radiation techniques spare the heart much more than earlier treatment approaches, but research is underway at the U-M Comprehensive Cancer Center to further reduce radiation exposure to the heart.
Radiation is one of several issues to consider, but cardiotoxicity is also a concern.
“The diagnosis of cardiac problems during cancer treatment can be difficult based on symptoms alone, as some of them, such as fatigue, shortness of breath, and swelling, can be caused by the adverse effects of chemotherapy. Therefore, when patients present with these symptoms, it is important to have cardiac evaluation,” says Dr. Yamada.
Heart problems linked to cancer treatment include heart failure, chemotherapy-induced hypertension, arrhythmias, thromboembolism (blood clots) or cardiac ischemia, a sudden severe blockage of a coronary artery that can lead to a heart attack.
About one-third of cancer patients who receive cancer drugs such as trastuzumab (Herceptin) and anthracyclines will develop cardiotoxicity. A small percentage of these patients will have to stop therapy because of side effects.
“Our goal will be early detection and to protect patients with heart medications,” says Monika Leja, MD, a cardiologist at the University of Michigan. ■