Cardio-Oncology helps keep your heart healthy during cancer treatment and survivorship

The same treatments that can save you from cancer may also raise your risk of heart complications. As part of our complete approach to care, UAB Medicine’s Cardio-Oncology Program monitors and minimizes patients’ risk of heart complications before, during, and after cancer treatment.

“Cardiovascular disease is the second-leading cause of death among cancer survivors, second only to cancer itself,” said Carrie Lennemen, M.D., the cardiologist who leads this program. “Our specialists are available from the time of diagnosis onward to respond to any increased risk for complications.”

The Cardio-Oncology Program identifies patients at high risk for complications, monitors their heart function during treatment, and provides long-term follow-up care for survivors at the UAB O’Neal Comprehensive Cancer Center. Team members may become part of your larger treatment team if a cardiology concern arises.

Risk assessment and prevention

Patients with pre-existing heart conditions, high blood pressure, or diabetes will be referred to the Cardio-Oncology team. They may recommend things that make the planned treatment safer – such as losing weight or taking blood pressure medication – and advise on your cancer medication regimen. “We collaborate with your treatment team for a balanced approach and keep you informed all along the way,” Dr. Lenneman said.

Common medications

Dr. Lenneman says certain cancer treatments can increase the risk of complications such as heart failure, high blood pressure, and arrhythmia (abnormal heartbeat). The likelihood of heart issues depends on the type of treatment and individual patient factors. Being aware of this reality and managing the impact can reduce risk for patients and keep their cancer treatment on track.

A few of the medications that can lead to cardiac complications include:

• Anthracyclines (i.e. doxorubicin, daunorubicin) may weaken the heart muscle over time.
• Management: Beta blockers or ACE inhibitors may be prescribed to help lower blood pressure, slow the heart rate, and reduce heart strain.
• Tyrosine kinase inhibitors (TKIs) (i.e. imatinib, sunitinib) can cause high blood pressure and increase heart strain.
• Management: Patients may need blood pressure medications, and the TKI dosage may be adjusted in some cases.
• Immune checkpoint inhibitors (ICIs) (i.e. pembrolizumab, nivolumab) may trigger myocarditis (inflammation of the heart) in rare cases, which can be life-threatening if untreated.
• Management: Steroids and immunosuppressive therapy can reduce inflammation and prevent serious complications.
• Certain chemotherapy drugs can cause fluid retention and swelling, leading to shortness of breath or heart strain.
• Management: Diuretics may help reduce excess fluid buildup, and lifestyle changes such as lowering sodium intake also can help.

Specialty care for long-term health

“We see patients at various stages of their cancer journey,” Dr. Lenneman said. “Some come to us before starting treatment, because their oncologist flags them as high-risk. Others develop heart issues during therapy, and we help manage those complications so they can continue treatment safely. And many survivors are referred to us because their long-term heart health needs monitoring.”

Cardio-oncologists help patients adopt lifestyle changes to improve their heart health during and after treatment. These changes may include:

• Exercise – Moderate physical activity tailored to a patient’s abilities helps maintain heart function.
• Heart-healthy diet – Cardio-oncologists help patients build a diet rich in fruits, vegetables, whole grains, and lean proteins. Limiting processed foods and sodium can help control blood pressure.
• Managing blood pressure, blood sugar, and cholesterol – It’s important to continue controlling cardiovascular risk factors even after completing cancer treatment. Visits with Cardio-Oncology may be part of patients’ ongoing checkup schedule.

“We know that cancer treatment is already overwhelming, so we do everything we can to make heart care easier,” Dr. Lenneman said. “We meet patients where they are – whether that’s seeing them in the Infusion Center, offering telehealth visits, or making appointments at one of our multiple locations. Our goal is to prevent delays and make sure that heart health doesn’t become a barrier to cancer care.”

Your oncologist will connect you with the Cardio-Oncology Program if heart-related concerns arise at any time. The UAB O’Neal Comprehensive Cancer Center offers cardio-oncology services at The Kirklin Clinic of UAB Hospital and The Kirklin Clinic at Acton Road. Telehealth appointments are also available.