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What is Cardio-Oncology at Lee Health?

Cardio-Oncology is one of the most rapidly growing specialties across the national and international healthcare sphere. The number of programs, educational  courses and scientific publications is increasing dramatically. Fellowship training programs and guidelines from multiple cardiovascular and oncologic societies are emerging and providing best practice strategies. 

Patients with cancer may have a higher risk of developing cardiovascular disease since cancer therapies may affect the heart and vascular systems. It is important to prevent, monitor, and treat cardiovascular disease in cancer survivors and patients to ensure long-term health.

Our cardio-oncologist have advanced training and have dedicated themselves to learning more about how cancer therapy affects the heart.  Collaborating with other cardiologists and oncologists provides comprehensive cardiovascular care to patients with cancer who have, or are at risk for, heart disease.

We seek to evaluate patients so that cancer therapy can be aggressive -- and to ensure that cardiac disease is not the result of that aggressive therapy.

Cardio-Oncology: The link between cancer and the heart

Hi, this is Dr. Anita Arnold. I am the director of cardio-oncology for Lee health. And I'd like to take a few minutes to tell you more about cardio-oncology, in particular the link between cancer and heart disease.

So what exactly is cardio-oncology? It is a new medical subspecialty of cardiovascular medicine and one of the fastest-growing subspecialties. It trains cardiologists with a strong interest in oncology. We work with physicians and others caring for cancer patients. We monitor the cardiovascular effects of therapy to prevent acute and long term cardiac dysfunction. This is while the patient is having therapy and for years afterwards. Why do we need cardio-oncology, there are increasing numbers of cancer survivors 13 point 7 million now with 18 million estimated by 2023. Recent studies showing seven year follow-up of adult cancer survivors show that 30% of those folks died of cardiac disease. But what was really interesting was 50% of that cardiac disease was directly related to the cancer therapy. childhood cancer survivors are expected to survive more than 80% at five years. Their subsequent mortality is not usually from cancer recurring, it's from the treatment they got related to their first cancer. And at 30 years, the mortality from treatment exceeds that of recurrent cancer. This is extremely important when people are getting their cancer therapy at the age of five years old. 10 years old. 30 years later, they're still extremely young but have a high mortality from cancer and heart disease. cancer survivors you can see by this slide, it's really quite interesting by 2040 the majority of the cancer survivors are all over 50 years of age. And starting from the green line. You can see 65 and up so it's really an older population which is more prone to getting cardiac disease as so which patients would need cardio-oncology? Do you need cardio-oncology, we strive to take care of cancer patients who are undergoing treatment with potentially cardiotoxic therapy, be it chemotherapy, immunotherapy or radiation therapy. We take care of patients who have known cardiac disease to make sure after they have developed cancer, they can withstand the rigors of the treatment. And as alluded to before we monitor survivors, especially the childhood cancers who have a 50% risk of death in their lifetime related to cardiac disease, not recurrent cancer. So some interesting facts about cardio-oncology, about 30% of all cancer patients will develop some cardiovascular complications due to their treatment. If a man lives more than five years after getting hormone therapy for his prostate cancer, he's more likely to die of cardiac disease, and in general, women are more affected by cancer treatment cardiotoxicity primarily because of breast cancer. But men are more likely to develop heart failure that is irreversible. Childhood survivors of cancer are seven times more likely to have heart disease than their siblings, and 22% of all childhood cancer survivors that have been treated with chest radiation, develop a stiffness of their hearts that ultimately leads to heart failure later in life. So how exactly does cancer therapy affect the heart, it can do it by many different mechanisms, the result of which is severe hypertension, premature atherosclerosis, you can get abnormal cholesterol and triglycerides based on therapy valvular heart disease, which is most likely associated with late-onset radiation abnormalities, stroke, abnormal EKG, the blood vessels can be damaged by the therapy. A rhythm is can be induced, especially atrial fibrillation, you can get heart failure, you can get fibrosis or stiffness of the heart, you can get pericardial disease, which is the SAC that surrounds the heart. And you can get blood clots either in the lungs called pulmonary embolism to the brain which is a stroke or clots to the heart, which can result in a heart attack. We know that in the United States, cancer and heart disease are the two biggest healthcare issues today. In the US one out of every two women will die of heart disease or stroke. One out of every eight women will get breast cancer and one out of 800 men will get breast cancer Essentially if you have one disease and live long enough, the chances are you will get the other. What we are trying to do with cardio-oncology is to treat cancer therapy but not substitute one disease, cancer for another heart disease.

What's interesting is there a shared risk factor in biology for both, so you are more likely to develop cardiotoxicity from your cancer therapy if you have heart disease already, or risk factors for heart disease. survivors of childhood cancer treated with any cardio cardiotoxic agents, including radiation are at increased risk of cardiovascular disease and survivorship years. The longer you are cancer-free, the more likely you are to develop heart disease. If you were to go to the American Heart Association and look at what are the risk factors for cardiac disease, you're going to find they will comment on smoking, physical inactivity, being overweight, eating an unhealthy diet, having diabetes, high cholesterol or high blood pressure. If you went to the World Health Organization and looked at what are the risk factors for cancer, you would find that more than 30% of cancer can be avoided if we took care of the following risk factors, which again are tobacco, obesity, a poor diet low and fruits and vegetables, inactivity, alcohol use and sexually transmitted HPV infection, there are a lot of similarities. Also, the biology supports inflammation, obesity, diabetes, hypertension, tobacco, a diet rich and fats, physical inactivity, and alcohol all contribute to both cancer and heart disease, so we can start to work on both sets of shares. treatment is also somewhat similar for cardiac disease we use blood thinners, blood pressure medication, certain diabetic medications, we advocate exercise healthy diet and statens. for cancer, cancer patients are more likely to develop blood clots and occasionally have to be put on blood thinners. Some chemotherapies can really increase the blood pressure meaning patients will need blood pressure medicine, diabetes can be made worse with cancer therapy. Exercise has shown to improve overall performance in cancer patients diet is helpful as tolerated. There is information regarding statens and its helpfulness in breast cancer, and pancreatic cancer has been linked to with certain hypertension medicines as being helpful and protective. The take-home message is there is extensive overlap in risk factors and disease prevention for cardiovascular disease and cancer, which suggests that these diseases have common basic molecular pathways. chronic inflammation may have a role because it contributes to both diabetes and occurs in obesity, diabetes, hypertension, and dyslipidemia. And controlling cardiovascular risk factors can help reduce the risk of cancer or cardiotoxicity from cancer therapy, which is the mainstay of cardio-oncology therapies.

For more information about cardio-oncology, please feel free to call the Regional Cancer Center or our Fort Myers office or Coconut Point Estero office and we'd be delighted to chat with you further.

Our program goals

  • Ensure better outcomes for patients with heart disease and cancer
  • Recognize early cardio toxicity from therapy
  • Prevent, reduce, and if possible, reverse cardiac damage
  • Monitor patients with potential cardiac issues undergoing chemo or radiation therapy
  • Understand cardiac issues during cancer therapy
  • Remove cardiac disease as a barrier to effective cancer therapy
  • Participate in establishing best survival practices for cardiac surveillance after therapy

Who is it for?

  • The focus is on three groups:
  • Those with existing heart disease who develop cancer to ensure their heart can withstand the stress of treatment. All these patients need to see their cardiologist to be referred.
  • Those who are considered cancer survivors and have either undergone radiation therapy with portals that have included the heart, or received cardio toxic regimens.
  • Those currently undergoing chemotherapy with cardio toxic agents to monitor for subtle changes in cardiac function that may signal an early decrease in cardiac function. 

What treatments do we provide?

Risk Assessment

Before undergoing medical or surgical treatments for cancer, it is important to understand your risk for developing cardiovascular disease. We work closely with your oncologist and provide a comprehensive evaluation before cancer therapy to minimize any potential cardiovascular complications from cancer treatment. We combine a complete, personalized assessment with appropriate diagnostic testing and optimal cardiovascular therapies.

Care for Cancer Patients with Existing Cardiovascular Disease

Management of conditions such as hypertension, coronary artery disease, congestive heart failure, heart valve disease and arrhythmias (abnormal heart rhythms) in cancer patients requires an approach customized to their overall care. Our goal is to treat existing cardiac conditions so that you are healthy enough to respond well to your cancer treatment.

Monitoring for Cardiac Complications                  from Cancer Therapy

If you are actively receiving chemotherapy or have previously completed chemotherapy and/or radiation therapy, you may experience symptoms related to hypertension, coronary artery disease, congestive heart failure, valvular heart disease, pericardial disease and arrhythmias. With early recognition and treatment, many complications of chemotherapy and/or radiation therapy can be managed successfully.

Assessment of Long-Term Cardiac Risk in Cancer Survivors

There is increasing evidence that shows that survivors of cancer face higher risks of cardiovascular disease. We provide a comprehensive risk assessment that includes a detailed history, physical examination, lab work and diagnostic testing. Strategies to reduce cardiac risk include dietary and lifestyle modifications and, when appropriate, medical therapy.

Assessment of New Chemotherapies

Many of the new chemotherapeutic agents in clinical and pre-clinical studies have the potential to damage the heart. We administer advanced diagnostic tests to identify cardiotoxicities for patients undergoing treatment with new chemotherapies. These may include diagnostic imaging, noninvasive stress testing, blood tests, ambulatory blood pressure monitoring and continuous monitoring of a patient’s heart from a remote location can help identify cardiotoxicities and lead to the development of preventative strategies.

Evaluation of Cardio-Toxicity

At Lee Health, we have advanced ultrasound imaging including 3D and cardiac strain imaging to detect subtle changes in the heart before they become clinically evident which is crucial for cancer management. In our evaluation we are looking at the effects of cancer therapy on the cardiac tissue, structures, blood supply, and system function.

What You Should Know

  • Heart disease and cancer have shared biology and risk factors
  • It is well established that cancer survivors die of cardiovascular disease in greater numbers than recurrent cancer
  • The number of cancer survivors is increasing dramatically and the majority of those are over 65 (the so-called silver tsunami of cancer care).
  • The number of novel cancer agents is extraordinary both in their efficacy and their adverse cardiovascular effects which necessitates a strategy to care for these patients during active treatment and beyond
  • Childhood cancer treatments have lasting cardiac effects, these patients need to be monitored lifelong
  • Data exists to demonstrate that patient care, patient and provider satisfaction, and Quality of Life for cancer patients are all increased with a coordinated Cardio-Oncology program, while costs and interruptions in cancer therapy are lowered with such programs.

Why Lee Health?

Lee Health has been involved with Cardio-Oncology for years already. 

We have been represented on the Cardio-Oncology Council of the American College of Cardiology, and our lead for the program, Dr Anita Arnold, is on the Board of Directors of the International Cardio-Oncology Society (I-COS), serves as the Chair for the Education Committee, has participated in International and National programs, with multiple publications, and is certified by I-COS in Cardio-Oncology. 

Who to contact