Cancer care and cardiovascular health can intersect in many ways, from people with existing heart issues who are diagnosed with cancer and need help managing treatment to people who have cardiovascular side effects from their cancer treatments.
At the University of Colorado Anschutz Cancer Center, the University of Colorado Cardio-Oncology Program is committed to providing cardiovascular care to patients with cancer and survivors of childhood and adult cancer. The program offers a variety of faculty expertise, clinical services, educational outreach, and multidisciplinary research.
“Cardiovascular disease is still the number one killer in the United States, so we know that there's a real importance to managing the cardiovascular health of every patient throughout their entire lifetime,” says Lavanya Kondapalli, MD, director of the cardio-oncology program.
In addition to Kondapalli, cardio-oncology faculty at CU Anschutz include Caitlin Bell, MD, Allison Fike, MSN, Julie Michalek, NP, Nicole Prabhu, MD, Raymundo Quintana, MD, and Maciej Tysarowski, MD.
Lifelong care
Kondapalli, who was the first fellow in the then-new field of cardio-oncology at the University of Pennsylvania in the early 2010s, came to CU Anschutz in 2014 to start the cardio-oncology program, which serves adult patients.
“We have great relationships with Children's Hospital Colorado and the CU Anschutz Cancer Center,” says Kondapalli, associate professor of cardiology at the CU Anschutz Department of Medicine. “We manage patients with cardiotoxicity who are being taken care of at Children's when they transition into the adult space and also provide longitudinal cardiovascular care for patients referred from the cancer center.”
Managing treatment side effects
Cancer treatments such as chemotherapy, radiation therapy, immunotherapy, and targeted therapy can affect heart function, damage heart tissues and blood vessels over time, and trigger blood pressure spikes, leading to long-term cardiovascular issues. The breast cancer drug Herceptin (trastuzumab), for instance, can cause an asymptomatic drop in heart-pumping function.
“Unfortunately, if it drops enough, it can lead to treatment being held,” Kondapalli says. “But it's really important for women to be able to complete a course of trastuzumab in terms of their overall survival from breast cancer. This is a great example of where we get involved. We get patients on the right cardiac meds to manage this drop in ejection fraction, so that women can continue to receive trastuzumab.”
Pre-existing conditions
People with coronary artery disease and other heart conditions also need special consideration when it comes to cancer treatment, Kondapalli says. People who have received stents to open narrowed arteries, for instance, are usually on antiplatelet drugs to keep the stents working properly. But cancer therapies can change the equation.
“When patients get on cancer treatment, sometimes their platelet counts can drop, and that becomes a very common thing for us to manage,” Kondapalli says. “How do we balance the need for the antiplatelet drugs to keep the stents open with the cancer treatment that is going to cause their red blood cell counts and their platelets to drop? Then also, how do we continue to manage their coronary artery disease? Because the risk of developing future coronary artery disease doesn’t stop just because you're on chemo.”
That’s where the cardio-oncology program’s focus on survivorship comes in. The team works with cancer survivors to maintain their long-term cardiovascular health.
“We are always talking with our survivors about getting their cholesterol checked every year, making sure their blood pressure is under control, screening for diabetes, making sure people are exercising to the guidelines of the American Heart Association,” Kondapalli says. “We are focusing on how to keep their hearts healthy, so they have long, healthy lives after cancer.”
Stewards of care
Kondapalli says her favorite part of her job is the relationships that she and her team build with patients over time, as they help them navigate their cancer journey.
“It's very rewarding, because you have these long-term relationships with people, and you help them through a very difficult time in their life,” she says. “When you get a cancer diagnosis, of course, that's incredibly difficult. But on top of that, when you find out that there's something wrong with your heart, that is extremely stressful. Being a steward of people's cardiovascular care during that time is very meaningful.”
