As if battling cancer isn’t challenging enough, many cancer patients have another “big C” to contend with: Cardiovascular disease.

Not only do some cancer patients have coexisting cardiovascular disease, but several treatments that improve survival in cancer patients can damage the heart in the process. These concerns have given rise to the medical subspecialty of cardio-oncology, designed to optimize each cancer patient’s treatment while minimizing the risk of cardiovascular complications.

“There’s a whole new world of treating cancer patients from a cardiovascular standpoint,” says Dr Diego Sadler, who is leading the development of Cleveland Clinic Florida’s cardio-oncology programme. “Heart disease can have a significant impact on cancer patients. It’s being recognized more and more often that many of the cancer therapies that are very important to survival can produce heart damage.”

As the World Heart Foundation commemorates World Heart Day on September 29, the link between cancer treatment and heart disease is a noteworthy correlation for The Bahamas, a nation plagued by both diseases.

Heart disease is the second leading cause of non-violent death among men. Meanwhile, Bahamian women battle aggressive breast cancer a decade earlier and two stages later than their counterparts around the world due to the prevalence of the BRCA gene.

As oncologists treat cancer, they also have to consider how each treatment impact other aspects of a patient’s health. For instance, some therapies can complicate blood-sugar control in diabetes patients – a disease declared a “national epidemic” in The Bahamas.

However, as oncologists work to bring each patient’s cancer under control, they might not always recognize the cardiac side effects of the treatments they administer, says Dr Thomas Samuel, breast cancer oncologist at Cleveland Clinic Florida’s Maroone Cancer Center. “Medicine is such a big field now that nobody can know it all,” he explains. “Having specialized care is so key to providing cutting-edge and excellent care to all our patients.”

A growing need for cardio-oncology
Several types of anti-cancer drugs—anthracyclines, trastuzumab, fluorouracil, and tyrosine kinase inhibitors, among others—can cause an array of cardiovascular problems, such as heart failure, cardiac arrhythmias, coronary artery disease, heart attack and stroke. Similarly, radiation therapy delivered to the chest may contribute to heart failure and coronary artery disease, although oftentimes these complications don’t manifest until years later.

“You need a good clinical cardiologist with knowledge and background in cardiac imaging and an interest in cancer drugs,” Dr. Sadler says. “There’s a commitment to learning the new side effects and toxicities of these drugs as they come to the market. Cardio-oncology is very dynamic and reinventing itself all the time, based on advances in drug therapy.”

Cardio-oncologists provide care not only for patients who develop cardiovascular complications from cancer treatment, but also heart disease patients who are beginning cancer treatment, patients at increased risk for heart disease, patients with cardiac tumors, childhood cancer survivors and others who received treatment in the past and develop new cardiac problems.

For those who may not have any option but to seek care outside of The Bahamas, Dr. Sadler and colleagues employ a full range of diagnostic studies and imaging modalities, such as state-of-the-art quantitative strain imaging and 3D echocardiography, to detect any cancer treatment-related cardiovascular complications as early as possible.

He and other Cleveland Clinic Florida cardiologists administer early pharmacological treatment of chemotherapy-related cardiotoxicity, and perform the latest in advanced interventional and surgical treatments for patients with valve problems, pericardial disease or coronary artery disease resulting from radiation therapy. They also provide specialized medical and surgical interventions for patients with end-stage heart failure caused by their cancer treatment.

“This is a new area involving the combined work and interaction of heart doctors and cancer doctors where we’ll utilize the most sophisticated cardiac imaging with quantitative technology that will allow us to achieve early detection and treatment of heart problems in order to maximize cancer treatment in a safe way,” Dr. Sadler explains.

Multiple disciplines, one goal
Just as Cleveland Clinic Florida’s Maroone Cancer Center oncologists work together to discuss the best treatment strategies for each patient, they’ll also collaborate with Dr. Sadler and colleagues at the Cleveland Clinic Florida Heart & Vascular Center to minimize the effects that those treatments have on the heart, while still providing the highest-quality cancer care.

“We provide a very multidisciplinary approach,” Dr. Samuel says. “If you come to a place like Cleveland Clinic that has a specific doctor dedicated to the issues that relate between cancer and cardiac disease, that just adds to the safety net we can provide while you receive cancer treatment.”