Cardio-Oncology: Cancer and Heart Disease

At Cooper and Inspira Cardiac Care, our highly trained physicians — Cardio-Oncologists — specialize in the cardiac care of patients who have cancer. Although it is a relatively new specialty, cardio-oncology is an important field, focused on the detection, monitoring, treatment, and prevention of cardiovascular disease that occurs as a side effect of cancer treatments. These treatments — chemotherapy and radiation therapy — are effective at helping to defeat cancer but sometimes cause damage to the heart and cardiovascular system.

The mission of our cardio-oncologists is to help to prevent cancer and heart disease through prevention and early detection as well as to improve the cardiovascular health of patients who have cancer or are cancer survivors. These two diseases are the leading causes of death in both men and women: heart disease is the #1 cause of death, and cancer is the #2 cause. We work at the intersection of both diseases to evaluate and treat patients in a variety of ways.

Cardio-oncology is focused on the detection, monitoring, treatment, and prevention of cardiovascular disease that occurs as a side effect of cancer treatments.

Helping to Detect Cancer Early

Our focus is always on our patients’ total health, knowing that prevention is the best medicine. During a cardiac visit, we take the opportunity to ask our patients if they are up to date with cancer screening. We find that when we pose this question many of our patients are not. Our patients lead busy lives (and may avoid seeing a doctor until they suspect something is wrong), but cancer screening is key to an early diagnosis. We ask our female patients: Did you have your mammogram? Have you had a Pap smear or colonoscopy recently? We always address any family history of both heart disease and cancer.

Helping Patients Before They Receive Cancer Treatment

Sometimes a patient who has been diagnosed with cancer also has a cardiac issue that is discovered through testing and imaging. The heart muscle function may be diminished. The patient may have high blood pressure or an abnormal heart rhythm found with an EKG. We like to see these patients early, well in advance of any regimen to treat their cancer, to make sure that that their hearts are strong enough to allow them to receive and tolerate whatever chemotherapeutic agents or radiation may be prescribed.

Patients have a range of imaging studies, such as CT and MRI scans, because imaging is often essential to detect tumors and create a treatment plan. An echocardiogram — an ultrasound of the heart — will reveal the heart’s size, its pumping capacity, and valve function as well as the integrity of its lining. An echocardiogram can also give physicians other important information about heart function — the ejection fraction, or EF, which is used to help make decisions about initiating and continuing chemotherapy.

If imaging shows an issue that may affect the heart or cardiovascular system, or if the patient has active symptoms or is considered to be high risk based on risk factors for heart disease, the oncologist makes a referral for further evaluation.

We work at the intersection of heart disease and cancer: the leading causes of death in both men and women.

We work together — oncologist and cardio-oncologist — to restore our patients to health. The goal of the cardiologist is to prepare the patient for chemotherapy or radiation. Some patients may need cardiac procedures with close consultation between our experienced teams to achieve the best results.

Maritza Cotto, MD

Clinical Cardiologist and Cardio-Oncologist

Helping the Patient During Cancer Treatment

Over the past several years, oncologists have recognized the importance of referring patients to a cardiologist with expertise in cardio-oncology before treatment is started. If cardiac issues can be diagnosed and treated early, the patient can finish their cancer therapy.

However, occasionally, cardiac issues occur during a chemotherapy regimen.

One of our patients who recently underwent chemotherapy also had a heart condition. This patient arrived at the hospital and was experiencing significant chest pain. Imaging and diagnostic tests showed a significant blockage that could lead to a heart attack. The main artery that is responsible for about 40% of the blood flow to the heart muscle was dangerously blocked. Working with the patient’s oncologist, we knew that we had to temporarily stop the chemotherapy because the patient had to be treated for coronary artery disease.

The patient received a stent, and then the question became “When do we go back to chemotherapy?” We decided to wait a few months to allow the patient’s heart muscle to recover. We gave her the appropriate medications to treat her heart. The patient resumed chemotherapy, completed her cancer treatment, and is now a breast cancer survivor.

Radiation therapy used in cancer treatment can affect the heart and vascular system.

Helping the Patient Who Is Undergoing Chemotherapy

Oncologists have a good understanding of the potential complications of treatment. Many chemotherapeutic drugs affect virtually every bodily system. Patients who are undergoing chemotherapy will likely experience nausea, vomiting, and temporary hair loss. Oncologists inform their patients of what to expect.

Patients who are undergoing chemotherapy may have chest pain and swelling of the legs, and they may become anemic and feel weak. With all of these symptoms, which sometimes include depression, it can be difficult to tell the difference between a potential cardiac problem and the side effects of chemotherapy. We remind our patients to pay attention to cues that may indicate a cardiac issue. Those cues may be subtle, but it’s important to know about any symptoms that may require further investigation.

Chemotherapeutic drugs can affect virtually every bodily system.

After Cancer Treatment

Cancer survivors have experienced a lot of physical and emotional stress. This experience can be exhausting, but the good news is that they beat their cancer! However, some patients can experience problems even after they are finished with their treatment. They might not be seeing an oncologist because they are “clear” and are feeling well, or they might have relocated and may have no local oncologist.

One example is late cardiotoxicity. Radiation therapy used in cancer treatment can affect the heart and vascular system. Cardiotoxicity can develop within days or months after radiation but often develops years later. This complication can reduce the patient’s quality of life and increase the risk of cardiac complications.

Radiation therapy to the chest area often is part of the treatment for Hodgkin lymphoma and cancers of the lung, esophagus, or breast. Radiation therapy has improved significantly, and patients are safer from inadvertent radiation exposure to healthy parts of the body. However, radiation to the left side of the chest may increase the risk of blockage in the arteries of the heart because of damage to the heart valves. Unfortunately, this damage may not become apparent until years after radiation treatments are completed.

We remind our patients is keep track of the medications and therapies they receive over the course of treatment: the amount of radiation, the medications or chemotherapy agents, and the length of treatment. Also important is why these treatments were discontinued. This information is important in the event that cardiac or oncologic conditions occur later. In some cases, if a patient receives a chemotherapy agent and another agent is added, the risk of heart disease may increase.

Cardio-Oncology at Cooper and Inspira Cardiac Care

With a greater emphasis on early detection and many new advanced treatments, the outlook for patients with cancer has never been better. The same can be said of heart disease. Our experienced cardio-oncologists are here and available to help our patients prevent and beat their cancer while maintaining a healthy heart. If you have questions or concerns, please call us to make an appointment with our cardio-oncology team. We’re here for you.