Cardio-oncology and Onco-Cardiology Programs: Treatments for Cancer Patients with a History of Cardiovascular Disease
Curator: Aviva Lev-Ari, PhD, RN
- Cardio-oncology Program @ Dana Farber Cancer Institute and the cardiovascular division at Brigham and Women’s
- Cleveland Clinic’s Cardio-Oncology Center
- Cardio-Oncology Program @ Cedars-Sinai, Los Angeles
- Cardiovascular Medicine & Oncology Program @ Yale School of Medicine – Cardio-Oncology Program
- University of Michigan Cardiovascular Center Cardio-Oncology Clinic
The Program of the 3rd Annual Canadian Cardiac Oncology Network Conference, June 20 – 21, 2013, Ottawa Convention Centre, indicate the need for collaboration between Oncologists and Cardiologists, as below:
New Discipline of Cardioncology evolves as Cancer Patients now Live Longer
October 08, 2010
Some of the new anticancer drugs are so effective they can keep tumors in check, but it’s their cardiac side effects that can threaten to cut life short. A death from therapy-related heart failure in a patient whose cancer is in remission may be the ultimate irony—the deathblow coming from collateral damage even while the war on cancer is being won.
This imagery of collateral damage comes from an editorial introducing the September/October 2010 issue of Progress in Cardiovascular Disease s, dedicated to the management of cardiac disease in cancer patients. It also points out that patients with early-stage breast cancer are now more likely to die of heart disease than cancer, highlighting the need for a new discipline that focuses on the treatment of cardiovascular disease in cancer patients.
The journal issue celebrates the first year of existence of the International Society of Cardioncology .
The society was launched last year at a meeting in Milan, Italy, explained Dr Daniel Lenihan(Vanderbilt University, Nashville, TN). This was the Third International Symposium of the Cardiology Oncology Partnership, and it attracted around 120 attendees. About half were cardiologists, 40% were oncologists, and the remaining 10% were “somewhere in between,” Lenihan said. The 2010 meeting started this week in Nashville and runs through October 9.
“The discipline of cardioncology has been evolving for about five years now,” said Dr Douglas Mann(Washington University School of Medicine, St Louis, MO), who coauthored the introductory editorial [1].
Although there had been an awareness of cardiac problems from cancer treatments for about 20 to 30 years—especially cardiotoxicity from anthracyclines leading to heart failure as well as coronary disease and valvular disease from radiation, particularly when directed at the thorax, he explained—the field was jolted into life by the totally unexpected reports of cardiac damage with novel, highly targeted anticancer agents.
Trastuzumab (Herceptin, Genentech), the HER2-targeted antibody used in breast cancer, was the “first shot across the bow,” the first time that cardiac damage leading to heart failure was seen outside of the anthracyclines, and it “was completely unexpected,” Mann said in an interview.
Then came the reports of heart failure with the tyrosine inhibitors, initially with imatinib (Gleevec, Novartis) and more recently also with sunitinib (Sutent, Pfizer). These side effects were also unexpected and also came as a shock to the medical community, Mann recalls. At the time, he wrote an editorial in Nature Medicine to highlight the problem [2].
Cardio-oncology: A new focus for cardiovascular medicine
HemOnc Today, August 10, 2011
W. Gregory Hundley, MD
Albini W. Gregory Hundley, MD, is the director of the Cardiovascular Magnetic Resonance Program, and professor, Internal Medicine (Cardiology) and Radiology at Wake Forest School of Medicine in Winston-Salem, N.C. Disclosure: Dr. Hundley reports having received research grants and funding from Bracco Diagnostics and Siemens.
Worldwide efforts during the past several years have improved cancer-related survival, such that cancer survivorship has tripled from 1970 to 2000. Today, there are more than 12 million cancer survivors in the United States.
As cancer-related survival has improved, an unexpected increase in premature cardiovascular events, including myocardial ischemia and myocardial infarction, stroke, and the development of congestive heart failure, has occurred. Associations have been identified between medications used to treat cancer and CV events. Long-term cancer survivors now represent one of the largest and fastest-growing patient populations at risk for premature CV disease. In fact, increases in CV-related morbidity and mortality now threaten to offset some of the advancements in cancer-related survival.
Currently, however, research initiatives, clinical management and guidelines are lacking, regarding addressing the needs of cancer survivors. In this article, we review the current knowledge related to the etiology, diagnosis, treatment and management of CV disease in cancer survivors and present concepts by which the CV and oncology communities can work together to address the CV needs of cancer survivors.
Chemotherapeutic agents that promote CV injury
As shown in Table 1, multiple agents are linked with CV injury after treatment for cancer. The agents most commonly associated with injury include the anthracyclines such as doxorubicin and alkylating agents such as cyclophosphamide. Recently released agents such as the tyrosine kinase inhibitors have also been associated with CV complications. TKIs regulate multiple cellular functions (including cellular proliferation, differentiation and survival) and are overexpressed in certain malignancies. TKIs include a diverse group of therapies that “down-regulate” malignant cell functions.
Trastuzumab (Herceptin, Genentech) is one of the more frequently described TKIs associated with decrements in left ventricular function. This agent is a monoclonal antibody that targets extracellular HER-2 that can be overexpressed in breast cancer tumors. Interestingly, this receptor is also expressed on developing cardiomyocytes. The association of trastuzumab with CV injury is thought to be related to the drug’s affinity with the HER-2 receptors on cardiomyocytes.
 W. Gregory Hundley |
Sunitinib (Sutent, CPPI CV) is another TKI that has recently been associated with hypertension. Sunitinib inhibits angiogenesis by blocking the activity of VEGF. Although the association of sunitinib with hypertension is not fully understood, it may be related to the reduction in production of vasodilators such as nitrous oxide and prostacyclin, resulting in vasoconstriction and decreased renal excretion of sodium.
Androgen deprivation therapy (ADT) represents another class of cancer treatments that is associated with CV events. Androgen suppression accelerates atherosclerosis and is associated with insulin resistance, obesity, metabolic syndrome, MI and cardiac death. Among 37,443 veterans with prostate cancer, treatment with ADT was associated with diabetes (adjusted HR=1.28); coronary artery disease (adjusted HR=1.19); MI (adjusted HR=1.28); and sudden cardiac death (adjusted HR=1.35). These adverse associations are noteworthy and have prompted initiation of primary CV prevention in many older men scheduled to receive these agents.
Susceptibility and detection
Much of the data relating to susceptibilities to CV injury emanates from the study of children or adults on protocols in which they received anthracycline-based chemotherapeutic agents for the treatment of hematologic malignancies, lymphoma, breast cancer or soft tissue sarcomas. Those more likely to experience anthracycline-related injury are women, those aged older than 65 years or younger than 15 years, and those with pre-existing CV disease or CV risk factors. When compared with their siblings, 14,358 survivors of pediatric cancer followed up to 30 years after their cancer diagnosis were three times more likely to develop a chronic CV event. To date, however, there are relatively few data regarding the factors that increase the risk for a CV event in patients receiving other chemotherapeutic agents.
Currently, intramyocardial biopsies remain the gold standard methodology for identifying myocyte injury as a result of chemotherapy administration. Importantly, however, this technique requires an interventional procedure and is not well-suited for repetitive examinations. For this reason, both radionuclide ventriculography and transthoracic echocardiography (TTE) are widely used to identify marked deteriorations in left ventricular systolic performance when patients receiving chemotherapy or those surviving chemotherapy experience symptoms suggestive of congestive heart failure.
Importantly, these radionuclide ventriculography or traditional 2-D echocardiography methods only identify relatively large deteriorations in left ventricular performance that are most often only associated with clinically overt heart failure. Several recent small studies suggest that quantitative applications regarding MRI or speckle tracking TTE identify the possibility that subclinical markers of CV injury may be identified before more clinically evident overt congestive heart failure ensues. With MRI or TTE, this is achieved through identification of abnormal myocardial tissue characteristics or quantitative assessments of myocardial strain or vascular function. Currently, larger studies are necessary to determine the potential efficacy of these noninvasive modalities for identifying early evidence of myocardial injury that may forecast future CV events.
Prevention and treatment strategies
For those at risk for CV injury before receipt of potentially cardiotoxic chemotherapy, dosing changes either through dose reduction, an alteration of dosing schedules, or a change in the mode of administration of a chemotherapeutic agent have been shown to reduce the risk for CV injury after chemotherapy. Regarding anthracycline toxicity, the cardioprotective agent dexrazoxane (Zinecard, Pfizer) is known to reduce early myocardial injury during anthracycline treatment; however, it remains controversial as to whether this class of agents may reduce the efficacy of cancer treatment.
For those who have experienced CV injury upon receipt of chemotherapy, several small studies have demonstrated potential benefits of angiotensin converting enzyme inhibition or beta-blockade with carvedilol (Coreg, GlaxoSmithKline) to help avert left ventricular remodeling and further deterioration of left ventricular ejection fraction.
Addressing CV concerns in cancer survivors
To date, there are no widespread structured protocols, guidelines or programs that focus on CV care and survivorship-related issues. In 2006, a report from the Institute of Medicine, titled From Cancer Patient to Cancer Survivor: Lost in Transition, sought to raise awareness of the needs of cancer survivors through a series of recommendations. One of the strongest recommendations was to provide comprehensive summary of treatment delivered and detailed plans for undergoing care to patients at the completion of their cancer treatment. Currently, however, there are few organized groups of physicians that are assimilated who can deliver CV care to cancer survivors.
This lack of focus has several major implications. First, although there are specific CV conditions associated with the administration of cancer therapy, there are no standardized definitions for CV disease associated with cancer therapy. Second, most protocols implementing current surveillance measures for cardiac injuries are not coordinated through a central effort; therefore, the selection of outcomes (eg, biomarkers, imaging results) is inconsistent across studies. Third, because CV surveillance is not the primary outcome measure for most of the protocols implemented to test the efficacy of new cancer therapies, there has been inadequate data to provide phenotypic or genotypic characteristics of patients who may be at risk for developing CV disease. Finally, medical societies and health care delivery systems have not determined the optimal pattern for physician surveillance of CV disease in cancer survivors. Thus, although the Institute of Medicine suggests that greater needs and resources should be dedicated toward patient care for most survivors in the US, assessment and treatment of concerns related to CV care are often incomplete.
SOURCE
Building Bridges: Cardio-Oncology and Onco-Cardiology
Sandra M. Swain, MD, FACP
16 Nov 2012 11:02 AM
We also had a panel discussion on onco-cardiology programs. Overall, it seems that the physicians who have these programs find that they are very well received and integrated into the care of patients with cancer. Dr. Edward T.H. Yeh, Chair of the Department of Cardiology at M.D. Anderson, discussed the terminology for physicians in such programs; specifically, the second part of the term should indicate the person’s position. For example, within the program, I am a cardio-oncologist, and Dr. Ana Barac, with whom I work at MedStar Heart Institute, is an onco-cardiologist.
There’s so much we can learn from one another. For example, in survivors of childhood cancers, the incidence of severe cardiac events by age 50 is 17%! This was a shocking number for me to hear. Also, many of these younger patients don’t get the appropriate follow-up they need to pick up on these events early so they can be less life-threatening.
On a related side note, I also found out that ASCO had 818 participants in the Cardiac Co-Morbidity Boards we put together for ASCO University last year. There were three modules—one for trastuzumab, one for TKIs, and one for VEGF signaling pathway inhibitors. I really thank my cardiology colleagues for their very active participation and engagement in developing these modules. ASCO members can access these modules by logging in with their ASCO.org account information. Nonmembers can access the modules by creating an ASCO.org Guest Account.
Cancer and the Heart
Onco-Cardiology
On 3 and 4 November 2010, more than 200 physicians, scientists, and healthcare professionals from 14 countries gathered in Houston, Texas, for the First International Conference on Cancer and the Heart. This event was co-sponsored by The University of Texas MD Anderson Cancer Center and the Texas Heart Institute, two international leaders in the treatment of cancer and heart disease. Although similar meetings have been sponsored in the past, by us and by others, this meeting was remarkable for its scope and ambition. It was our intent to show that basic science can be used successfully to guide translational and clinical research. This First International Conference has heralded the coming of onco-cardiology as a research and clinical subspecialty.
In this conference, cardiovascular complications were discussed in modules that comprised heart failure, imaging, radiation, thrombocytopenia, cardiac masses, and hypertension. Clinical experts from MD Anderson and other institutions presented updates on timely clinical topics, followed by question-and-answer sessions. A significant portion of the conference was devoted to basic mechanisms that drive paradigm shifts in this emerging field. Major discoveries were reported on a new paradigm for anthracycline-induced cardiotoxicity and vascular complications caused by some targeted agents. The role of prior exposure to doxorubicin in trastuzumab-induced cardiotoxicity was also discussed. Early identification of cardiotoxicity using biomarkers or left ventricular strain imaging has commanded significant attention. The proceedings of these modules are summarized concisely in the accompanying articles. This conference was not designed to cover the entire field, but rather to create a model for future conferences. Consequently, there are many important clinical issues and basic mechanisms that remain to be covered in future meetings.
In addition to the clinical and basic-science modules, there was a session on the dialogue between patient and doctor. As physicians, we are in our comfort zone when illness is defined by medical terms and laboratory numbers. It is refreshing to hear about it from a patient’s perspective: illness is a personal affliction that alters one’s sense of wellness and self-esteem. Indeed, this conference is dedicated to all cancer patients who have suffered cardiovascular complications.
A decade ago, MD Anderson had 2 in-house cardiologists and referred most cardiovascular complications to surrounding hospitals in the Texas Medical Center. As the complexity of our patient population grew, it became difficult to obtain timely consultation and treatment for our patients. Consequently, the Department of Cardiology at The University of Texas MD Anderson Cancer Center was established in 2000. I was recruited as the founding chair with the charge to develop a comprehensive cardiology service and to develop basic and clinical research relevant to cancer and the heart. The service now consists of 11 cardiologists, 7 physician extenders, 2 pharmacists, and 5 rotating cardiology fellows who provide comprehensive cardiac care to cancer patients. We have also built a cardiac catheterization laboratory that performs cardiac biopsies, diagnostic studies, and the implantation of pacemakers. We have strong basic research laboratories that have published their findings in prestigious scientific journals. Our experience is not unique because several institutions in the United States and Europe have already established “onco-cardiology” (or “cardio-oncology”) units. These centers include Memorial Sloan-Kettering Cancer Center (New York) and the European Institute of Oncology (Milan). Each onco-cardiology unit faces different challenges that are associated with the size of the hospital, its affiliation with other general hospitals, and the scope of cancer treatments. Smaller onco-cardiology units are also emerging within major medical centers in the United States. These small units usually have cardiologists who have developed an interest in taking care of the heart problems of cancer patients, in addition to the problems encountered in a general cardiology practice. As these onco-cardiology units proliferate, it is important to establish communications between them in order to share common experiences and extraordinary challenges.
Onco-cardiology is a medical subspecialty concerned with the diagnosis and treatment of heart disease in cancer patients. Clearly, this field is not limited to cardiologists, but also includes medical oncologists, radiation oncologists, surgical oncologists, and all others who are interested in caring for cancer patients with cardiac problems. A major issue that our field must define is the scope of the core knowledge that needs to be shared by all practitioners. Furthermore, we must educate our cardiology and oncology colleagues about the importance of providing optimal cardiac care to cancer patients. These efforts should bring about improved clinical outcomes and enhance the development of new anticancer therapies. As cancer therapy becomes more effective and as more cancer patients become cancer survivors, it is the goal of the “onco-cardiologist” to ensure that our patients will have healthy hearts to enjoy their new lives.
Leading Cardio-oncology and Onco-Cardiology Programs in the US
Cardio-oncology Program @ Dana Farber Cancer Institute and the cardiovascular division at Brigham and Women’s
The Cardio-Oncology Program, a joint collaboration of Brigham and Women’s Hospital and Dana-Farber Cancer Institute, is one of a select few of its kind in the country. Led by Anju Nohria, MD, a cardiologist with special training in epidemiology and heart failure, and Javid Moslehi, MD, a cardiologist with additional training is molecular oncology, the Program provides care for cancer patients with a history of cardiovascular disease or those who develop cardiac complications. The program includes both clinical and research components.
About Us
This innovative program is one of the few in the United States dedicated to addressing the cardiovascular side effects of cancer therapy and maximixing cardiovascular outcomes for cancer survivors.
The specific goals of this Program are as follows:
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Provide care for patients with a cardiovascular history who now have to undergo cancer treatment, both medical and surgical procedures;
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Provide care for patients who present with heart failure following traditional treatments associated with cardiac dysfunction including anthracyclines, radiation, and newer agents such as herceptin;
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Study the potential cardiovascular complications of novel molecular targeted therapies – including arrhythmias, cardiomyopathy, cardiac ischemia, and hypertension – and establish treatment strategies for these complications
Working together as a team in the care of the cancer patient, the goal of the Program is to minimize cardiotoxicity during cancer treatment and cardiovascular risks during cancer survival.
Services @ Dana Farber Cancer Institute and the cardiovascular division at Brigham and Women’s
The cardio-oncology program brings together oncologists from the Dana-Farber Cancer Institute and expert cardiologists from Brigham and Women’s Hospital to provide optimal cardiovascular care for the cancer patient. The uniqueness of this program hinges on the close working relationship of our oncologists and cardiologists.
Both the Dana Farber Cancer Institute and the cardiovascular division at Brigham and Women’s have been world leaders in providing innovative and comprehensive care to patients with complex diseases. We are now combining these efforts to bring novel diagnostic methods and innovative therapies to patients with cardiovascular manifestations of cancer and cancer therapy.
Our comprehensive cardio-oncology program provides care for:
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Patients with existing cardiovascular issues who have newly diagnosed cancer and need to be shepherded safely through the medical and surgical treatment for their cancer.
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Patients who may have cardiac side-effects from traditional cancer therapies, such as anthracyclines and radiation. Working closely with our oncology colleagues, we monitor and adjust therapy for these patients with the goal of preventing further cardiovascular complications while effectively treating the underlying cancer.
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Patients being treated with novel molecular targeted therapies that may have potential adverse cardiovascular effects. Our cardio-oncology specialists are fostering research that may lead to an improved understanding of the mechanisms by which novel cancer drugs affect the cardiovascular system. This work may help identify patients at risk for developing cardiovascular complications and may also help design better and less cardiotoxic cancer treatments.
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Patients who are long-term cancer survivors and need to be screened and treated for cardiovascular issues that may or may not be related to their treatment.
Contact Us
Javid J. Moslehi, MD – Co-Director
Anju Nohria, MD – Co-Director
Research @ Dana Farber Cancer Institute and the cardiovascular division at Brigham and Women’s
The Cardio-Oncology Program at Brigham and Women’s Hospital and Dana-Farber Cancer Institute includes both basic and clinical research components.
Dr. Javid Moslehi is a cardiologist with postdoctoral training in molecular oncology at the Dana-Farber Cancer Institute. Dr. Moslehi’s cardio-oncology research program includes both basic and translational components. Dr. Moslehi is specifically interested in cardiovascular toxicities of novel molecular targeted therapies. While novel chemotherapies have revolutionized cancer treatment, they can lead to potential adverse cardiovascular effects. Better understanding of the mechanisms underpinning adverse cardiovascular effects with novel targeted therapies can lead to better understanding of normal cardiovascular function and may lead to strategies that prevent cardiotoxicity of these agents. Dr. Moslehi seeks highly motivated medical students and postdoctoral fellows for this unique research program. Please send inquiries and CV to Javid Moslehi, M.D. Email: jmoslehi@partners.org or javidmoslehi@gmail.com.
Dr. Anju Nohria is a cardiologist with expertise in heart failure and transplantation. She has done extensive research on the management of acute decompensated heart failure and is currently focused on evaluating, prevention and treatment strategies in patients who develop cardiomyopathy and other cardiovascular complications as a consequence of cancer therapy. She has additional training in epidemiology and is interested in the cardiovascular health of cancer survivors.
Publications:
Javid Moslehi, YA Minamishima, Robert F. Padera, Sabina Signoretti, Ronglih Liao, and William G. Kaelin. “Loss of PHD Prolyl Hydroxylase Activity in cardiomyocytes phenocopies ischemic cardiomyopathy.” Circulation. 122: 1004-1016, 2010.
Ergun Sahin, Simona Colla, Marc Lissa, Javid Moslehi, Florian Muller, Mira Guo, Marcus Cooper, Darrell Kotton, Attila Fabian, Carl Walkey, Rick Maser, Giovanni Tonon, Friedrich Foerster, Robert Xiong, Alan Wang, Sachet Shukla, Mariela Jaskelioff, Eric Martin, Tim Heffernan, Alexei Protopopov, Elena Ivanova, Jon Mahoney, Maria Kost-Alimova, Samuel Perry, Roderick Bronson, Ronglih Liao, Richard Mulligan, Orian Shirihai, Lynda Chin, and Ronald Depinho. “Telomere-directed Mitochondrial Dysfunction Contributes to Degenerative Decline in the Telomerase Deficient mouse.” Nature. 470:359-365, 2011.
Christopher J. Richards, Youjin Je, Fabio A. B. Schutz. Daniel Heng, Susan Dallabrida, Javid Moslehi and Toni K. Choueiri. “Incidence and risk of congestive heart failure in patients with renal and nonrenal carcinoma treated with sunitinib.” Journal of Clinical Oncology. 29:3450-3456, 2011.
Babak Nazer, Benjamin Humpreys, and Javid Moslehi. “Effects of Novel Angiogenesis Inhibitors for the Treatment of Cancer on the Cardiovascular System: Focus on Hypertension.” Circulation. 124:1687-1691, 2011.
Imran Uraizee, Susan Cheng, and Javid Moslehi. “Reversible cardiomyopathy associated with suntinib and sorafenib.” New England Journal of Medicine. 365:1649-1650, 2011.
Javid Moslehi and Peter Libby. “You can’t run from inflammation: lower extremity ischemia, hypoxia signaling, and macrophage subtypes.”Circulation Research. 110(8):1045-6, 2012.
Javid Moslehi, Ronald Depinho, and Ergun Sahin. “Telomeres and mitochondria in the Aging Heart.” Circulation Research. 110:1226-1237, 2012.
William Querbes, Roman Bogorad, Javid Moslehi, Jamie Wong, Amy Chan, Akin Akinc, Elena Bulgakova, Satya Kuchimanchi, Victor Koteliansky, Wiliam G. Kaelin, Jr. “Treatment of Erythropoietin Deficiency with Systemically Adminstrated siRNA.” Blood. 120:1916-1922, 2012.
Nilka de Jesus-Gonzales, Emily Robinson, Javid Moslehi, Benjamin D. Humphreys. “Management of Antiangiogenic Therapy-induced Hypertension.” Hypertension. 60:607-613, 2012.
John Groarke, Dan Tong, Jay Khambhati, Susan Cheng, and Javid Moslehi. “Breast Cancer Therapies and Cardiomyopathy.” Medical Clinics of North America. 96:1001-1019, 2012.
Tomas Neilan, Otavio Coelho-Filho, Diego Pena-Herrera, Ravi Shah, Michael Jerosch-Herold, Sanjeev Francis, Javid Moslehi, Raymond Kwong. “Left ventricular mass in patients with cardiomyopathy after treatment with anthracyclines.” American Journal of Cardiology. 110:1679-1686, 2012.
Tomas Neilan, Otavio R. Coelho-Filho, Ravi V. Shah, Jiazuo H. Feng, Deigo Pena-Herrera, Damien Mandry, Francois Pierre-Mongoen, Bobak Heydari, Sanjeev Francis, Javid Moslehi, Raymond Y. Kwong, Michael Jerosch-Herold. “Myocardial extracellular volume by cardiac magnetic resonance imaging in patients treated with anthracycline-based chemotherapy.” American Journal of Cardiology. 111(5):717-22, 2013.
Javid Moslehi. “The Cardiovascular Perils of Cancer Survivorship.” New England Journal of Medicine. 368(11):1055-6, 2013.
Steven Bair, Toni Choueiri, and Javid Moslehi. “Cardiovascular complications associated with novel angiogenesis inhibitors: Emerging evidence and evolving perspectives.” Trends in Cardiovascular Medicine. 23(4):104-13, 2013.
John Groarke, Paul L. Nguyen, Anju Nohria, Roberto Ferrari, Susan Cheng, and Javid Moslehi. “Radiation therapy and cardiovascular disease.” European Heart Journal. In press.
Javid Moslehi and Susan Cheng. “Cardio-Oncology: A Novel Platform for Basic and Translational Research.” Science Translational Medicine. In Press.
Bonnie Ky, Pimprapa Vejpongsa, Edward TH Yeh, Thomas Force, and Javid Moslehi. “Emerging Paradigms in Cardiomyopathies Associated with Cancer Therapies.” Circulation Research. In Press.
Cleveland Clinic’s Cardio-Oncology Center
Cancer survival has improved over the years due to newer and better forms of treatment with chemotherapy and radiation. When treating cancer, some of the treatments may cause lasting damage to your heart. This is especially true if you are at risk for heart disease.
The goal of Cleveland Clinic’s Cardio-Oncology Center is to help you complete your cancer treatment without developing such damage. We use state-of-the-art technology to identify and immediately treat the toxicity. Our care does not change or interrupt your cancer therapy.
Our team includes specialists from the Sydell and Arnold Miller Family Heart & Vascular Institute (including cardiac imaging, heart failure, electrophysiology and cardiac surgery) and the Taussig Cancer Institute. The team works together to provide expertise in diagnostic testing, medical management, and interventional and surgical procedures for patients.
This multidisciplinary team of doctors, nurses and healthcare professionals is dedicated to caring for patients in every stage of cancer treatment who are at risk for, develop or have established cardiovascular disease.
The Cardio-Oncology Center provides care to patients in varying stages of cancer treatment who have or are at risk for heart disease. Our range of services includes evaluation and treatment of patients:
- Who will begin cancer treatment and have risk factors for heart disease
- Who will begin cancer treatment and are being treated for heart disease
- Who are undergoing chemotherapy or radiation and develop symptoms of weakness or fatigue;
swelling of the legs and feet; chest pain; irregular heart beats; and/or dizziness - Who have had cancer treatment in the past and develop new cardiac problems
- Who have had radiation therapy in the past and need surgical or interventional treatments
- Who have developed advanced heart failure due to previous cancer treatment and need advanced treatment, such as a heart pump or heart transplant
- Who have a cardiac tumor
Our team of healthcare professionals offer patients:
- A full range of imaging techniques and diagnostic studies. These allow for early detection of heart and blood vessel damage and arrhythmias. These tools include cardiovascular exam, electrocardiogram (ECG), and state-of-the-art echocardiography, including 3D, contrast and strain imaging.
- Collaborative medical management. Our cardiologists and oncologists will discuss your test results. Together, we will design the best cancer treatment plan for you. This includes the choice of treatment, dosage and schedule.
- Ongoing follow-up care during cancer treatment. This lets us find and treat heart and vascular changes early in your care and work to create the best long-term outcomes possible.
- Continued care after cancer treatment. You can develop heart damage (cardiotoxicity) within the first year after therapy, and even several years after therapy. We provide follow-up care and early treatment, if needed.
- Advanced surgical options for patients with valve and pericardial disease caused by previous radiation therapy.
- Advanced heart failure therapies, such as specialized medical treatment, artificial heart pumps and heart transplantation, for patients with end-stage heart failure caused by chemotherapy or radiation.
Why choose Cleveland Clinic for your care?
Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don’t hesitate to ask.
Leaders in the field from America’s top ranked Heart Program and one of America’s top Cancer Programs are working together to offer you the best diagnostics and treatment possible.
Cleveland Clinic’s Section of Cardiovascular Imaging pioneered the clinical use of strain imaging. This is an innovative technique that allows early detection of cardiotoxicity. This helps determine the best plan for cancer treatment and predict the amount of heart damage it will cause.
Cardio-Oncology Assessment Tool
Did you know some cancer treatments may affect your heart health? Know the signs and symptoms to look out for and see if an evaluation at the Cardio-Oncology Center is recommended for you.
References
- Negishi K, Negishi T, Agler DA, Plana JC, Marwick TH. Role of Temporal Resolution in Selection of the Appropriate Strain Technique for Evaluation of Subclinical Myocardial Dysfunction. Echocardiography. 2011 Dec 9. doi: 10.1111/j.1540-8175.2011.01586.x. [Epub ahead of print]
- Daher IN, Kim C, Saleh RR, Plana JC, Yusuf SW, Banchs J. Prevalence of abnormal echocardiographic findings in cancer patients: a retrospective evaluation of echocardiography for identifying cardiac abnormalities in cancer patients. Echocardiography. 2011 Nov;28(10):1061-7.
- Sawaya H, Plana JC, Scherrer-Crosbie M. Newest echocardiographic techniques for the detection of cardiotoxicity and heart failure during chemotherapy. Heart Fail Clin. 2011 Jul;7(3):313-21. Review.
- Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Cohen V, Gosavi S, Carver JR, Wiegers SE, Martin RP, Picard MH, Gerszten RE, Halpern EF, Passeri J, Kuter I, Scherrer-Crosbie M. Early detection and prediction of cardiotoxicity in chemotherapy-treated patients. Am J Cardiol. 2011 May 1;107(9):1375-80. Epub 2011 Mar 2.
- Banchs J, Jefferies JL, Plana JC, Hundley WG. Imaging for cardiotoxicity in cancer patients. Tex Heart Inst J. 2011;38(3):268-9.
- Hare JL, Brown JK, Leano R, Jenkins C, Woodward N, Marwick TH. Use of myocardial deformation imaging to detect preclinical myocardial dysfunction before conventional measures in patients undergoing breast cancer treatment with trastuzumab. Am Heart J. 2009 Aug;158(2):294-301.
- Albini A, Pennesi G, Donatelli F, Cammarota R, De Flora S, Noonan DM. Cardiotoxicity of anticancer drugs: the need for cardio-oncology and cardio-oncological prevention. J Natl Cancer Inst. 2010 Jan 6;102(1):14-25. Epub 2009 Dec 10.
SOURCE
http://my.clevelandclinic.org/heart/departments-centers/cardio-oncology.aspx
Cardio-Oncology Program @ Cedars-Sinai, Los Angeles
Heart disease remains the greatest health risk in women of all ages. While we have made great strides in detection and treatment of breast cancer, the number one threat in cancer survivors is heart disease. The Cardio-Oncology Program is a highly specialized clinic in the Barbra Streisand Women’s Heart Center dedicated to the heart health of breast cancer survivors. We understand that the use of radiation and chemotherapy has adverse effects on a woman’s future heart disease risk.
The Cardio-Oncology Program is directed by two leading physicians at Cedars-Sinai: Puja K. Mehta MD, a women’s heart cardiologist and Catherine Dang MD, a breast cancer surgeon. This unique clinic brings together experts from two of the most important areas that affect women. Our clinic specializes in identifying women who may be at increased risk of heart disease by a comprehensive history and physical, including breast cancer treatment history.
As a new patient, you will complete a questionnaire prior to your first appointment, which will help us pinpoint your individual risk factors for heart disease or other diseases common to women. Based on this initial evaluation and using state-of-the-art screening tests, an individualized prevention and treatment plan will be made. We see women who want to decrease their chances of heart disease as well as those who are looking for a second opinion for their heart health concerns.
Services available include:
- Personalized cardiac risk assessment with
- EKG, Exercise treadmill, Holter monitoring
- 2D transthoracic echo with tissue doppler, contrast if needed, bubble study; trans-esophageal echo
- Exercise and pharmacologic stress echo
- Exercise and pharmacologic SPECT and PET
- Stress cardiac MRI
- Cardiac CT angiography
- Coronary calcium score
- Carotid IMT
- Personalized, comprehensive preventive strategies for optimal heart health
- Nutrition counseling
- Cardiac rehabilitation
- Treatment of resistant high blood pressure
- Treatment of complex disorders of high cholesterol level
- High risk hormone therapy counseling through the Women’s Hormone and Menopause Program
- Specialized care in valvular heart disease, interventional cardiology, congestive heart failure and electrophysiology
SOURCE
Cardiovascular Medicine & Oncology Program @ Yale School of Medicine
Cardio-Oncology Program
Dr. Raymond Russell, Associate Professors of Medicine in Cardiology, is Director of the Cardio-Oncology Program at Smilow Cancer Hospital at Yale-New Haven. The program is designed to help address the cardio-toxic side effects of chemotherapy treatment, as well as the confounding problem of co-existing cardiac disease and cancer. The Program also provides pre-surgical and pre-treatment cardiac evaluation for patients with cancer.
The service began in response to emerging data, which indicates that newly developed drugs for cancer treatment are having unanticipated side effects. Drugs such as Herceptin, which is very effective in the treatment of breast cancer, can have cardio-toxic side effects that are just beginning to be understood and researched.
The difficulty when dealing with cardio-toxic side effects is that they can often mask themselves as normal effects from the cancer treatment itself, such as fatigue and shortness of breath. If it is determined that a patient has a pre-existing heart dysfunction, Dr. Russell can help make decisions of how treatment can be optimized, and establish what the baseline function is for continued monitoring.
If a patient is found to have cardio-toxicities during treatment with chemotherapy, the oncologist, the patient, and Cardio-Oncology Program will work together to decide what the best course of action is. There are many methods for treating mild heart failure, which would be beneficial if the cancer is responding to the chemotherapeutic drug. In some cases, collaboration with the oncologist will need to take place in order to change the chemotherapy to something that’s less cardio-toxic. The point is to kill the cancer cells, without damaging other areas. The goal of this Program is to help patients through their treatment so they have the best chance to be cured of their cancer.
Giving a patient as much information as possible about their treatment plan and what to expect is crucial. Another goal of the Cardio-Oncology Program at Smilow Cancer Hospital is to provide specialty care for patients who have cancer to help them not only deal with the effects of their chemotherapy on heart function, but also evaluate patients with co-existing coronary artery disease and cancer for specialized therapy where there may be increased risk to the heart. With new chemotherapeutic agents being developed, people are living much longer lives and a healthy heart is crucial to being able to enjoy that.
Modern cancer therapy offers the greatest chance to patients to beat their cancer, however, some of the established therapies are associated with cardiac toxicities. Similarly, some of the new, targeted chemotherapeutic agents can affect heart function or the electrical conduction system of the heart. The Cardio-Oncology Program at Yale School of Medicine was one of the first programs in the nation developed to address the unique cardiovascular problems faced by patients with cancer.
Kerry Russell, MD, PhD and Raymond Russell, MD, PhD, co-directors of the program, focus on three important areas:
- Addressing the cardiac complications of cancer as well as the cardiac complications of cancer therapy,
- Treating patients with coexisting heart disease and cancer, and
- Providing presurgical and prechemotherapeutic cardiovascular risk assessment.
University of Michigan Cardiovascular Center Cardio-Oncology Clinic
Heart Specialists Treat Both Heart and Cancer Patients – Dr. Elina Yamada and Dr. Monika Leja evaluate patients at risk for cardiotoxicity from cancer treatment.
Better treatment with chemotherapy and radiation therapy has reduced cancer deaths significantly. But for some patients, cancer treatment can cause lasting damage to the heart by aggravating existing heart problemsor creating new ones. The University of Michigan Cardiovascular Centerhas created the state’s first Cardio-Oncology Clinic with heart specialists focused on minimizing and preventing heart damage caused by chemotherapy and radiation. Only a handful of hospitals around the world have dedicated programs of scientists and physicians working to address cancer treatment’s impact on the heart.
Clinic Heart Specialists Focus on Preventing Heart Damage Caused by Cancer Treatment
Dr. Elina Yamada and Dr. Monika Leja evaluate patients at risk of, or who developed cardiotoxicity from cancer treatment. Without interrupting treatment, they work to identify and address cardiovascular risks and reduce the toxic effects of cancer therapies on the heart, what’s known among physicians as cardiotoxicity. (View a flippable PDF of the Winter 2013 issue of Thrive magazine, a publication for cancer patients and their caregivers. In this issue is an article featuring Drs. Yamada and Leja.)
Cardiovascular issues that can arise from cancer treatment include heart failure, heart attacks, high or low blood pressure and arrhythmias. As aggressive cancer drugs are used on older patients who may already have heart disease, and researchers identify a growing number of cardiovascular side effects of cancer treatment, making sure cancer patients have a healthy heart to enjoy the rest of their lives is gaining more importance.
Both Heart Patients and Cancer Patients Can Benefit from the Clinic
For heart patients, clinic doctors perform pre-surgical or pre-treatment evaluations for those patients with cardiac conditions who are also being treated for cancer, and provide medical care to improve heart function prior to a cardiac surgery or procedure.
Cancer patients, with or without known heart disease or risk, and cancer survivors can benefit from a clinical assessment of heart function and, if needed, continued medical care for the heart. About one-third of cancer patients who receive chemotherapy drugs such as trastuzuman (Herceptin) and anthrycyclines will experience damage to their heart cells. Working with the patient’s cancer team, doctors at the Cardio-Oncology Clinic evaluate and prescribe treatment to improve heart function without interrupting cancer treatment. Doctors also evaluate and treat cancer survivors when a major illness, injury or even pregnancy triggers a reaction by the heart to the toxic effects of previous cancer treatment. The U-M will use strain imaging, a specialized form of echocardiography, to provide a detailed analysis of specific segments of the heart in order to predict damage before it occurs.
Our Location
The clinic is in the University of Michigan Cardiovascular Center, a 5-level facility that unites the U-M Health System’s cardiovascular services, located at the heart of the medical campus at the corner of Ann and Observatory streets in Ann Arbor.
SOURCE
http://www.uofmhealth.org/university-michigan-cardiovascular-center-cardio-oncology-clinic
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This method combines medical (allopathic) treatment with training in Yoga, Meditation, and Stress Management. This combination can prevent coronary heart disease and reverse blockages in the blood vessels.
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