The last decade has brought a dramatic increase in the number of new cancer therapies, and many tumors that were uniformly fatal are now curable, or at least compatible with long-term survival. However, in many ways the diagnosis of cancer has been replaced by a new diagnosis – “cancer survivorship” – according to Thomas Andrews, M.D., a board-certified cardiologist and Clinical Associate Professor of Internal Medicine at UT Southwestern.
Dr. Andrews is also an onco-cardiologist, practicing in a relatively new area of medicine that treats the effects of cancer therapy on the heart and vascular system.
“Many new agents have unintended cardiac effects, including heart failure, coronary vasospasm, edema, and arrhythmias,” he says. “Determining the best way to monitor for these side effects and developing preventive strategies is the first job of an onco-cardiologist.”
Dr. Andrews adds that many cardiologists have little experience managing the complex issues that arise with side effects of these new therapies. In a cancer survivor with a new cardiac condition, numerous questions emerge: Was the cardiac condition caused by the cancer therapy? What is the prognosis and best therapy? Can an otherwise effective cancer therapy with a cardiac side effect be continued, or perhaps restarted after the cardiac condition has improved?
Decisions Take On New Complexity
Some patients have established cardiac disease at the time of their cancer diagnosis and pose another set of unique problems, Dr. Andrews notes.
“Many decisions that may be relatively straightforward take on a new complexity in the presence of a cancer diagnosis,” he says. “For example, should a patient with advanced cancer and coronary disease undergo coronary revascularization? How should advanced valve disease be managed? Should a patient with severe left ventricular dysfunction have a cardiac defibrillator implanted? Such decisions require knowledge of anticipated cancer therapies and integration of expected outcomes from cancer treatment into decision-making regarding cardiac treatment.”
Easy Access, Plus On-Site Testing
With the opening of its new Clinical Center Park Cities at the northwest corner of Hillcrest Road and Northwest Highway, UT Southwestern has greatly expanded its onco-cardiology clinical services. The new satellite clinic is conveniently located, offering easy access for patients and on-site testing capabilities, including echocardiography, stress testing, arrhythmia monitoring, and a host of other procedures.
“We can see patients on an urgent basis every weekday,” Dr. Andrews says. “Our goal is to be the regional referral center for cancer patients with cardiovascular concerns.”