What is Cardio-Oncology?
Cardio-Oncology is the management of cardiac complications of cancer treatment. Cancer treatment (both chemotherapy and radiotherapy) can potentially cause a variety of cardiac problems.
Cardiac complications of cancer therapy
Common chemotherapies (e.g. Herceptin, anthracyclines/doxorubicin/daunorubicin, R-CHOP, R-ESHAP, Velcade, Avastin, ABVD, FOLFOX, FOLFORI) can damage the heart muscle, coronary arteries and affect the heart rhythm. Potential cardiac complications of these therapies include heart failure, myocarditis (heart muscle inflammation), arrhythmias (e.g. AF or atrial fibrillation) coronary spasm and heart attacks.
Radiotherapy can also lead to cardiac complications in some patients with the commonest early problem being an inflammation of the heart muscle and lining (myopericarditis).
Both chemotherapy and radiotherapy can lead to cardiac complications months to many years down the line. These include the development of heart failure, heart valve disease and early coronary artery disease (increasing the risk of heart attacks at a younger age).
Role of the Cardio-Oncology service
The Cardio-Oncology services play a key role in preventing the development of complications and managing them if they occur. Dr Arjun Ghosh is the first Consultant Cardiologist in the UK to be appointed with the specific remit of managing cancer patients with cardiac issues. He has now brought this expertise to the independent sector to enable patients to receive world-class Cardio-Oncology care.
Pre-treatment assessment
The Cardio-Oncology service can assess the cardiac risk of a patient before the initiation of cancer treatment. The assessment includes a clinical examination followed by specialised cardiac tests e.g. echocardiography (ultrasound scanning of the heart looking at the heart muscle and valves). Home 24 hour monitoring of the blood pressure and heart rate may be required to further quality cardiac risk. Cardiovascular risk profile blood tests (blood sugar, cholesterol, kidney and liver function) complete the comprehensive assessment.
Monitoring during treatment
Cancer patients receiving potentially cardiotoxic therapy need to be monitored during the course of their therapy to detect cardiac abnormalities at an early stage to allow the prompt imitation of cardiac therapy. This monitoring may take the form of periodic echocardiography and blood tests.
Late Effects – detecting cardiac problems after treatment completion
Patients in the Late Effects’ setting are followed up to detect cardiac complications months to years after the completion of cancer treatment. These reviews include a clinical examination and history taking with appropriate ancillary investigations (e.g. ECG and echocardiography) as required.
Education and Research in Cardio-Oncology
Dr Ghosh is heavily involved in Cardio-Oncology education and research having published a number of papers in the field and is regularly invited to speak, nationally and internationally on the topic.