Cardio-Oncology Provides Cancer-Specific Cardiology Care and Research

[This feature also appears in the Fall 2014 Edition of Progress Notes, The Department of Internal Medicine's Quarterly Publication.
Click here to view the publication.]

Fall 2014 -- In 2013, veteran Cardiologist Dr. Michael Hess began VCU’s Cardio-Oncology Program to provide care for patients with cardiac complications as a result of cancer treatments. Cardio-oncology is an emerging area in patient care with a large patient population because many standard oncology treatments increase the risk of patients experiencing heart complications. VCU’s program is the only one in the state. After pioneering VCU’s Heart Failure Program, Dr. Hess is now leading VCU’s Cardio-Oncology Program as it cares for patients,
conducts research, and establishes new standards of care.

Oncology treatments, such as chemotherapy and radiation, put a burden on the cardiovascular system and increase the risk of heart issues. Dr. Hess points out that, “the second leading cause of death in adults who survive cancer is cardiovascular issues.” The practice of oncology-specific cardiology originally emerged as cardiologists recognized a link between chemotherapy and heart failure. With breast cancer in particular, the American Heart Association reports that “12 percent of older ... patients developed heart failure within three years [of treatment].”

Michael Hess, MD,
a veteran Cardiologist who pioneered heart failure care, leads the VCU Cardio-Oncology Program which provides specialized cardiology care to cancer patients with heart issues related to oncology treatments.

Despite knowing the negative cardiovascular effects of cancer treatments, these treatments effectively cure cancer. Therefore, Dr. Hess explains, “we work alongside oncologists as they cure and we identify and treat any cardiovascular risk factors that emerge. This strategy is best for the patients and allows them to lead a normal life in the long run, often with just a few medications.”

Another large challenge in the emerging area of cardio-oncology is that standard cardiology treatments are often not an option for patients because basic oncology treatments, such as radiation therapy or doses of anthracyclines, compromise their health and create irregular results during common cardiology scans. “The old rules are out and there are many questions,” says Dr. Hess. “But this is intriguing because it involves a lot of pure medicine and science.”
There is very little literature or standard of care protocol for cardiology complications brought on by oncology treatments. In addition to treatment, there is much research and protocol development to be done. For some specific treatments, such as bone marrow transplants, there is no literature on related cardiology issues. Having treated many of these cases, Dr. Hess is working on publishing descriptions of observed cardiac complications in bone marrow transplant patients.

“We work alongside oncologists as they cure and we identify and treat any cardiovascular risk factors that emerge. This strategy is best for the patients and allows them to lead a normal life in the long run, often with just a few medications.” – Dr. Hess

Given that the CDC identifies cancer as one of the leading causes of death in the United States and VCU’s Massey Cancer Center is the highest rated cancer center in Virginia, the patient population is a large one. The program has steadily grown in response to this — since starting with clinic hours on one day a week in 2013, the program now offers clinic hours everyday of the week.

To treat patients, the program works closely with Massey Cancer Center. When Massey oncologists see patients with heart risks, they are referred to the Cardio-Oncology Program Clinic for treatment. The program provides three main clinical services to patients. First, it works to provide preventative care by screening patients before they undergo oncology treatment. Next, it provides treatment to patients that develop heart issues in the course of being treated for cancer. Finally, when patients conclude cancer treatments the program sees patients to help them maintain good health into the future. The program also sees patients from other institutions as they are referred.

As Dr. Hess moves forward, he looks to add more cardiologists to the program and is exploring how VCU’s training programs can participate as well. “There is good work to be done in this area,” says Dr. Hess. “The administrative leadership is the best I have seen in my time at VCU. They have a great concept for building care and expertise and it allows us to advance programs like this one.” He looks forward to continuing to use his expertise and experience to pioneer care for patients with oncology treatment induced heart complications at VCU. | IM

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