Andrew Kohut, MD, imaging cardiologist at Pennsylvania Hospital, reviews what cardio-oncology is and why it’s important. Dr. Kohut outlines the intersection of cancer agents and cardiac disease through several case studies.
I presented this last month too patient patient families and potential donors as part of the Penn medicine development series at pennsylvania Hospital. I'm an imaging cardiologist focused on echocardiography and nuclear cardiology. And interestingly, my wife is an oncologist here at Penn also. And when we met 15 years ago, we never thought that our worlds would be so overlap now with all these new cancer agents and advances in cardiac imaging. So as we all know, heart disease and cancer, the number one and two causes of death in the us. What's interesting is this has not changed at all in the past 50 years. So what is cardio oncology and why is it important discoveries and innovations and cancer treatment have dramatically improved survival for cancer patients, allowing them to live longer. Fuller lives. However, these treatments damage and kill cancer cells. They also damage other parts of the body, including the heart. As we think about cardiovascular disease and cardiovascular risk factors in cancer biology and disease progression in cancer patients. There's a significant overlap and this is the overlap that cardio oncology is trying to unravel. For example, shortness of breath is one of the most common complaints among cancer patients undergoing active treatment with chemotherapy and radiation. Chest pain is also very common. Both symptoms are harbingers of potentially severe cardiovascular disease. First patient I want to discuss today, we'll call Sonja. She's a 55 year old woman who presented an outside hospital with shortness of breath. Cat scan showed suspected metastatic cancer and severe coronary calcification. She was transferred to pennsylvania hospital. Additional imaging showed widely metastatic breast cancer specifically to bone and lungs and severe multi vessel C. A. D. She developed acute toxicity after her first round of chemotherapy, including doxy Robinson causing mild heart failure. Question was posed. What should be done next? The appropriate clinical course really requires a team based approach and the answer to this question is going to really depend on the specifics of the patient in terms of comorbidities and other cardiac risk factors such as valvular heart disease, chronic kidney disease, diabetes and hypertension, as well as the patient's cancer profile And the potential need for anti her two monoclonal antibody treatment. This is an example of acute toxicity and this acute toxicity can limit access to life saving drugs. Another patient I want to briefly discusses Jason 41 year old man with non Hodgkin lymphoma. 20 years ago, treated with heavy doses of radiation and doxy Robison. He's fit has been very active throughout his life when I met him. I thought he was like a retired linebacker in the NFL but presented with worsening shortness of breath. We found that he was in complete heart block and he required urgent pacemaker placement. This is an example of chronic toxicity and chronic toxicity can limit quality of life morbidity as well as survival. This overlap in terms of cardiovascular disease and cancer, we're just now beginning to understand some of the toxicities include arrhythmias, cardio, maya, site damage, heart failure, ischemic, heart disease, valvular heart disease, pericardial disease, blood clots in the arterial and venous system as well as hypertension and some of the newest most effective cancer medications have really significant potential deleterious effects on the heart and the vascular system. Thankfully we have partners in our journey to understand these interactions between cardiac disease and cancer Therapies, American Heart Association, the American College of Cardiology and the NCC N. Focused on cardio and colleges, a new, rapidly evolving field. However, funding remains scarce. What we ultimately want to do is we want to improve cardiovascular health of patients with cancer and cancer survivors through personalized compassionate care provided by focused, interdisciplinary collaborative team. And what we really need moving forward is we need clinical research to drive high value care. We need dedicated research coordinators and clinical researchers focused on these cardio oncology questions. We need multidisciplinary clinical teams made up of physicians pharmacies as well as nurses, to really provide the best care for our patients. And we need community education outreach not only to patients, patient families, but also took some primary care physicians and other referring physicians as well as considering implementing some screening programs. And so with that, I'm going to close my talk. Thank you so much joe for allowing me to participate. I appreciate it.
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