Building Bridges: Cardio-Oncology and Onco-Cardiology

Building Bridges: Cardio-Oncology and Onco-Cardiology

Sandra M. Swain, MD, FACP, FASCO

Nov 16, 2012
I recently attended the Second International Conference on Cancer and the Heart at M.D. Anderson Cancer Center, which was endorsed by ASCO. I had the privilege to be on the organizing committee because of my long-standing interest in the cardiac effects of cancer therapy in patients with breast cancer. As I listened to the lectures, which were largely from the cardiology viewpoint, I realized more than ever how much our specialties intersect and what great opportunities we have to make a difference for our patients.

What is clear to me from this meeting is that it is extremely important that we continue to come together as oncologists and cardiologists to understand the underlying issues for each. For example, an audience member asked, “How many people do MUGA scans anymore?” He said, “I get referrals for a lot in my community but feel like it’s an outdated modality.” Only one or two hands out of about 200 were raised. The speaker replied with no reservation, stating: “This technique is outdated.”

There will always be controversy about many topics, but I think this kind of information—backed by evidence—is important for oncologists to know. As oncologists, we order the tests. For example, in a patient on trastuzumab (Herceptin), we order regular tests of the Ejection Fraction (EF). We need to know what the best test is for our patients and why! On the other side, the cardiologists need to know that patients getting adjuvant trastuzumab need one year for the optimal survival benefit. So if a patient’s EF drops, optimal cardiac management is critical so the treatment is not stopped early. I made that point after talking about a case and the light bulb went on for the cardiologists.

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 account information. Nonmembers can access the modules by creating an Guest Account.

So many interesting sidebar discussions too. What a great meeting!

So let’s keep these issues close to our heart! (Sorry, couldn’t resist.)


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