Many breast cancer patients will survive their cancer, but there is a chance that the treatment that helps them survive may also lead to cardiovascular complications like congestive heart failure. That’s why at the University of Colorado Anschutz Medical Campus, there is a team of experts in CU’s cardio-oncology program ready to help cancer patients navigate their cardiovascular health. At CU Anschutz, Caitlin Bell, MD, Lavanya Kondapalli, MD, Julie Michalek, NP, Nicole Prabhu, MD, and Raymundo Quintana, MD, are providers who specialize in cardio-oncology care.
“There can be long-term complications related to radiation therapy, chemotherapy, or other drugs given for breast cancer. Cardio-oncologists are cardiologists who manage these chronic cardiac conditions that can be the result of cancer treatment,” says Kondapalli, director of the cardio-oncology program. “A main concern is the complication of having congestive heart failure or cardiomyopathy, which is the weakening of the heart muscle, related to cancer treatment.”
Cardio-oncology is one of the newest fields of cardiology, explains Kondapalli, who practices at the UCHealth Heart and Vascular Center and at the CU Cancer Center.
“Ultimately, heart disease is the number one killer in the United States — not breast cancer,” says Kondapalli, an associate professor in the Division of Cardiology in the CU Department of Medicine. “We expect that most women will survive breast cancer. When we think about their overall survivorship and health, it’s important to make sure that we are aggressive about their heart health.”
Kondapalli was the first cardio-oncology fellow to graduate from the University of Pennsylvania in 2014, and she was recruited by Peter Buttrick, MD, who was head of the Division of Cardiology at the time, to come to CU and build a cardio-oncology program. A decade later, the program continues to grow and prove its value in elevating patient care.
“At Anschutz, we manage and steward the cardiovascular health of any person who is undergoing or has been exposed to cancer therapy that can cause damage to the heart, and we manage patients who have existing cardiovascular disease and then get diagnosed with cancer,” she says. “This includes childhood survivors of cancer who are now adults and adult survivors of adult cancer. The majority of patients we serve are people who either have existing cardiovascular disease and are going through cancer treatment, or those who have a cancer diagnosis and develop a cardiac complication from their treatment.”
From left to right: Lavanya Kondapalli, MD, Caitlin Bell, MD, Julie Michalek, NP, Nicole Prabhu, MD, and Raymundo Quintana, MD, are providers who specialize in cardio-oncology care at the CU Anschutz Medical Campus.
Understanding cardiac complications and the value of preventative care
The cardiac complications that can arise depend on the patient and the kind of treatment they receive. For instance, one of the cancer treatments that may be used is a class of drugs called anthracyclines.
“We do worry about long-term cardiomyopathy or congestive heart failure that can develop from that,” Kondapalli says. “Thankfully, the rates of that are very low.”
Another potential concern is the effect of radiation on cancer patients, as radiation treatments — especially to the left side of the chest where the heart is located — can create a risk of heart disease.
“Here at CU, we have strong relationships with all our oncologists and radiation oncologists, and with newer techniques in radiation oncology, we don’t anticipate we are going to see these late effects of radiation as much in the future,” she says.
The American Cancer Society reported that heart conditions like congestive heart failure, coronary artery disease, cardiomyopathy, damage to heart valves, inflammation of the heart muscle, and high blood pressure can develop or worsen after cancer treatment. Although there are risks of these conditions, Kondapalli emphasizes the value of preventative care among cancer patients and cancer survivors.
“When I really think about long-term cardiac side effects of breast cancer therapy, I think the vast majority of women will not have heart failure or these kinds of issues,” she says. “The bigger goal, to me, is to teach these survivors that being healthy from a cardiovascular standpoint is so important to your overall health.”
When it comes to her patients, Kondapalli asks herself how she can help support her patients achieve a healthy weight, maintain the American Heart Association’s recommendation of 150 minutes of aerobic exercise per week, eat a healthy diet, and manage their stress and blood pressure.
“How do we make sure that these cancer survivors are doing their preventative care? Because there is value in being preventative so that you don’t have to be reactive when something happens,” she says. “With good, regular follow-up care, the idea is that you can take steps to make it less likely that you might develop heart failure related to the cancer treatment you received.”
An evolving mission
Kondapalli is proud of the growth of the CU cardio-oncology program, saying it would not have been possible without the support of the CU Cancer Center and Division of Cardiology.
The team has recently grown to five health care professionals who work to care for patients at the UCHealth Heart and Vascular Center, CU Cancer Center, patients in the UCHealth network, and patients outside of the CU Anschutz Medical Campus. For example, the team provides virtual care to some patients in Colorado Springs and along the front range in partnership with local cardiologists.
“As cardio-oncologists, we provide comprehensive cardiology care to all patients regardless of cancer type,” she says. “I am happy and pleased with the growth we’ve had over the past 10 years, but there’s so much more to do. It’s exciting that we’re in a position to start looking ahead to the next 10 years.”
In the future, Kondapalli hopes the program will make more contributions to cardio-oncology data and research.
“The work of cardio-oncology — and the optimal management of how to take care of a woman who has gone through breast cancer treatment — is nuanced and there is so much we still need to learn,” she says.
The opportunity to innovatively brainstorm how to improve patient care was one of the reasons Kondapalli was drawn to the field of cardio-oncology.
“What is so exciting about cardio-oncology is that it’s emerging. The research, data, and questions are at their infancy, so it’s a great blend of being an expert in cardiology but also having the opportunity to address difficult clinical questions in a bit of a data-free area,” she says.
But ultimately, it is the relationships Kondapalli has built with her patients that remain one of the most rewarding aspects of her job.
“You go through this really difficult time in your patients’ lives, but you can also experience all the joy when they get through their health issues. You have this opportunity to have a very long, fulfilling relationship with patients,” she says. “It’s so rewarding.”
