Cardiovascular disease is the second leading cause of death among cancer survivors, second only to cancer itself.The same treatments that can save patients from cancer may also raise the risk of heart complications. The University of Alabama at Birmingham’s cardio-oncology program monitors and minimizes patients’ risk of heart complications before, during and after cancer treatment.
Carrie Lenneman, M.D., professor in the UAB Marnix E. Heersink School of Medicine, leads the team that identifies patients at high risk, monitors heart function during treatment and provides long-term follow-up care for survivors at the UAB O’Neal Cancer Center.
“Cardiovascular disease is the second leading cause of death among cancer survivors, second only to cancer itself,” Lenneman said. “Our specialists are available from the time of diagnosis onward to respond to any increased risk for complications.”
Patient perspective
Patients do not need to have an existing heart condition to be referred to cardio-oncologic care. Henry Cornelius, a patient in the cardio-oncology program, has witnessed the benefits of proactive care firsthand.
Cornelius was diagnosed in 2021 with stage IV prostate cancer. Since then, he has undergone a prostatectomy, completed two years of doublet therapy and received 40 sessions of radiation. He went into remission in 2023, but by mid-2024 began experiencing a biochemical recurrence and is preparing to resume treatment.
“Managing the toxicity from the oncologic treatment is one of the primary benefits of this program,” Cornelius said. “UAB is at the center of the cardio-oncology piece of my treatment. The proactive treatment plan has helped me avoid developing any heart conditions.”
Medications and screenings
Certain cancer treatments can increase the risk of complications such as heart failure, high blood pressure and arrhythmia, or abnormal heartbeats. The likelihood of heart issues depends on the type of treatment and individual patient factors. Awareness of this reality and managing the impact can reduce risk for patients and keep cancer treatment on track.
A few of the medications that can lead to cardiac complications include:
- Anthracyclines: May weaken the heart muscle over time.
- Tyrosine kinase inhibitors: Can cause high blood pressure and increase heart strain.
- Immune checkpoint inhibitors: May trigger myocarditis, or inflammation of the heart, in rare cases. This can be life-threatening if untreated.
- Hormone blocking therapy for breast and prostate cancer can accelerate metabolic changes (weight gain, elevate blood sugar, blood pressure and cholesterol).
- Certain chemotherapy drugs can cause fluid retention and swelling, leading to shortness of breath or heart strain.
The cardio-oncology program utilizes heart screening to catch any of the effects early, such as electrocardiograms, or EKGs.
“I get EKGs throughout the year,” Cornelius said. “This kind of testing is something that Dr. Lenneman recommends to catch any heart issues before they present.”
Management
Depending on the medication, management methods such as beta blockers, blood pressure medications, steroids or immunosuppressive therapy, and diuretics can reduce the risk of complications. The cardio-oncology team can recommend the best management option depending on the specific medications a patient is taking.
Cardio-oncologists help patients adopt lifestyle changes to improve their heart health during and after treatment. These changes may include exercising, implementing a heart-healthy diet and managing blood pressure.
“Ultimately, some impacts of oncologic treatment are out of our control; but lifestyle changes and other recommendations from the program have helped minimize those effects,” Cornelius said.
The team stays highly involved in patients’ follow-up care after treatment has concluded. Throughout each phase of Cornelius’ care, his heart health has been closely monitored and managed.
“I feel very lucky to have access to such holistic care and a multidisciplinary team at UAB,” Cornelius said.
Specialty care and risk assessment
The program sees patients at various stages of their cancer journey. Patients with preexisting heart conditions, high blood pressure or diabetes will be referred to the cardio-oncology team; but proactive care can help to avoid heart issues in the future.
The program works with the patient’s primary care physician, oncologists and larger treatment team to determine the best plan for each patient.
“We collaborate with their treatment team for a balanced approach and keep them informed all along the way,” Lenneman said.
The UAB O’Neal Cancer Center offers cardio-oncology services at both locations of The Kirklin Clinic, UAB Hospital and Acton Road. Telehealth appointments are also available.
“We know that cancer treatment is already overwhelming, so we do everything we can to make heart care easier,” Lenneman said. “We meet patients where they are. Our goal is to prevent delays and make sure that heart health does not become a barrier to cancer care.”