Fighting cancer can be hard on your heart. A new program from St. Mary’s Health Care System and Oconee Heart and Vascular Center helps patients who are undergoing cancer treatment protect their heart by providing early detection of cardiac problems.
St. Mary’s cardio-oncology program is the first of its kind in the Athens area. It uses innovations in imaging technology to uncover heart damage in its earliest stages, when the patient and his or her oncologist may still have options to fight the cancer while minimizing the risk of damage to the heart.
“Until now, oncologists had no way of knowing if cancer treatment was harming the patient’s heart until it was too late to do anything about it,” says cardiologist Erick Avelar, St. Mary’s chief of Cardiology and clinical director of St. Mary’s cardio-oncology program. “Now, we can provide information that can help oncologists and their patients make better-informed clinical decisions.”
A closer look
“The basic issue is that the medications used to fight cancer can be toxic to the heart,” said Dr. Avelar . “Patients are living longer after being diagnosed with cancer, especially breast cancer. But now, more cancer patients are dying from cardiovascular disease than cancer.”
The most common and most dangerous of these cardiovascular diseases is heart failure. In heart failure, the heart becomes too weak to pump blood effectively, leading to fluid build-up inside the body that stresses the heart and many other vital organs. This stress can lead to progressively worsening symptoms such as swelling of the feet and ankles, fatigue, shortness of breath, kidney failure, coma, and, ultimately, death.
Chemotherapy and radiation therapy also can lead to coronary artery blockages, arrhythmia, or swelling of the tissues around the heart. Problems are most common in patients with high risk factors for heart problems, including smoking, obesity, a sedentary lifestyle, a high-fat diet and family history of cardiovascular disease.
St. Mary’s cardio-oncology program makes use of upgraded MRI and echocardiography systems that are sensitive enough to detect very subtle damage to heart tissue. Armed with more detailed information than has been possible before, oncologists can work with patients to minimize heart damage while fighting the underlying cancer.
“With older technologies, we didn’t have the tools oncologists needed to assess the impact of cancer treatment on the heart,” Dr. Avelar said. “Heart damage could not be detected until ejection fraction – the amount of blood pumped by each contraction – began to decrease. By that time, the heart has already suffered a great deal of damage. With these new technologies, we can detect signs of potential damage earlier, often before the whole heart has been irreversibly weakened.”
Help in times of trouble
Another key component of the program is registered nurse navigator, who provides patients with education about imaging studies and lab tests, assesses patients for new and ongoing cardiac symptoms, monitors test results, and coordinates communications with the cardiologist.
Patients normally enter St. Mary’s cardio-oncology program during chemotherapy and may continue for months or even years afterwards. Patients and survivors undergo testing on a regular basis, usually every three months. Testing includes a clinical examination, non-invasive MRI, echocardiography testing and/or blood tests.
If the cardiologist sees warning signs of trouble, the patient may be asked to come in for more frequent testing. Throughout the process, the cardiologist stays in close contact with the patient’s oncologist, who can use the information to tailor cancer treatment to the patient’s individual needs.
In addition to providing patient care, Dr. Avelar is the lead researcher in a number of studies to improve the detection and treatment of heart changes related to cancer treatment. This spring, articles about two of his research projects were published in peer review journals.
In the first one, a review article titled, “Role of Imaging in Cardio-Oncology,” Dr. Avelar and his team describe how various imaging modalities, including echocardiography, MRI, CT and nuclear medicine, can be used to monitor heart function in cancer patients. While each modality has its pros and cons, cardiac MRI has the ability to detect subtle changes in heart size and function during cancer treatment more accurately than any other imaging modality and without exposing patients to radiation.
In the second article, Dr. Avelar reports on a pilot study that followed 20 women with breast cancer for six months after their diagnosis. The study looked at how effective cardiac MRI was in detecting changes to the size, shape and function of their hearts. MRI scans revealed changes in heart size and function not associated with heart failure, but the significance of those changes will need to be determined.
“This pilot study is a good foundation that we can build on in order to determine with a longer follow-up and a larger study population, whether the changes in heart size and function we observed are reversible, and whether they could lead to heart failure years from now,” he explained.
Dr. Avelar is a Level 3 cardiac imaging reader who completed his training at Massachusetts General Hospital, Harvard Medical School. He leads the Cardiac MRI/CT and Cardio-oncology programs at OHVC at St. Mary’s, and serves as an associate professor with the Augusta University/University of Georgia Medical Partnership in Athens. He is also the chief of cardiology at St Mary’s. He sees outpatients at OHVC’s main clinic near Watkinsville and at its Walton County clinic in Monroe.
For more information, contact Oconee Heart and Vascular Center at (706) 389-3440, or visit OHVC on the internet at www.oconeeheart.com.
St. Mary’s provides a wide range of breast health services:
• St. Mary’s Medical Group primary care physicians
• 3D screening mammography
• 4 mammography locations
• Saturday mammography hours in Athens
• Ultrasound studies
• Diagnostic mammography
• Breast MRI
• Breast health nurses
• Biopsy services (including minimally invasive stereotactic, MRI-guided, ultrasound-guided, and needle-guided biopsy services)
• Surgical services, including lumpectomy and mastectomy
• Reconstructive surgery
Learn more at www.stmarysathens.org.