When Cancer and Cardiology Collide

by Thomas Andrews, MD

Heart Talks

Twenty five years ago, I found myself at a professional crossroads, choosing between two very different subspecialties of internal medicine—cardiology and oncology. At that time, there was very little overlap between the two fields. There were only a few cancer treatments that affected the heart, and almost no interaction between specialists in the two fields. Several years later, a professional mentor developed advanced congestive heart failure as a result of his cancer treatment, and I was struck by the irony that a life-saving treatment came with such a marked cost in quality of life.

Since that time, many new treatments have been developed that dramatically improve cancer survival but have significant cardiac side effects. For example, recent studies have shown that an average 40-year-old breast cancer survivor has the exercise capacity of an otherwise healthy 70-year-old woman. So while the field of oncology is exploding with new and exciting treatments for cancers, these advances are creating a new group of patients, “cancer survivors,” with a whole host of unique conditions that have been poorly addressed by the medical community in the past.

I like this quote from the manuscript Lost in Transition (emphasis added): “Some cancers that were once uniformly fatal are now cured in nearly all cases.  And many of those who get common cancers become long term survivors. Other people may be living with a cancer that is controlled but not cured.  All of these individuals can be considered survivors of their disease, and also of their treatment.”

In the past 10 years, I have become increasingly interested in how to shield the cardiovascular system from unwanted side effects of cancer treatment and, when damage does occur, how best to treat cancer survivors with their unique cardiac conditions.

I am part of a team of basic scientists and cardiovascular clinicians at UT Southwestern studying this problem and caring for patients. Our goal is to help return cancer survivors to the highest possible quality of life after cancer. We call this subspecialty “Onco-Cardiology.”