Elina Yamada, M.D., and Monika Leja, M.D., will co-lead the new Cardio-Oncology clinic.

Heart and Soul

New clinic aims to reduce cardiac complications of cancer treatment

issue 17 | fall/winter 2012

The University of Michigan Cardiovascular Center has created a Cardio-Oncology clinic focused on preventing or minimizing heart damage caused by chemotherapy and radiation therapy for cancer. The new center will be led by cardiologists Monika Leja, M.D., and Elina Yamada, M.D.

"Advances in treatment have reduced cancer deaths, but in the past 10 to 15 years there's been an emerging trend of premature heart disease among cancer survivors," says Leja. "Using sophisticated imaging technology and biomarkers, we can better identify those patients whose hearts have been weakened as a result of cancer treatment."

The imaging technology utilized is called "strain imaging" and it allows physicians to get a detailed analysis of specific segments of the heart in order to predict damage before it occurs. In a promising, small-scale study of breast cancer survivors, strain imaging predicted issues up to three months earlier than monitoring ejection fraction alone.

Common cardiovascular complications linked to cancer treatment include heart failure, chemotherapy-induced hypertension, acute myocardial infarction and arrhythmias. "Our goal will be early detection and to protect patients with heart medications," says Leja, formerly of the MD Anderson Cancer Center, who joined the University of Michigan Health System in August.

U-M's Cardio-Oncology clinic will also treat rare, but potentially deadly, heart tumors. Heart tumors may either originate in the heart itself or spread from primary tumors in nearby organs such as the lungs or kidneys.

''If we ignore what's happening in the heart, we could lose the gains we've made in cancer survival.''

Monika Leja, M.D

Roughly 75 percent of primary cardiac tumors are benign, but they can lead to serious heart problems and interfere with the heart's normal functioning. Leja says, "Heart tumors that are malignant require aggressive care with multidisciplinary team input, as will be provided by this clinic."

Preventing heart disease in cancer patients is gaining more importance as aggressive cancer therapies are applied to older patients and as researchers identify a growing number of cardiovascular side effects of anti-cancer therapy. Careful evaluation of heart disease in cancer patients will likely improve quality of life but may also improve mortality as the presence or development of heart disease may significantly limit lifesaving cancer therapies.

"If we ignore what's happening in the heart, we could lose the gains we've made in cancer survival," Leja says. "Heart disease, and not cancer, poses the larger risk to the 2.2 million breast cancer survivors in the United States. About one-third of cancer patients who receive chemotherapy drugs such as trastuzumab (Herceptin) and anthracyclines will develop cardiotoxicity, meaning drugs designed to inhibit cancer cells also injure heart cells. A small percentage of these patients will have to stop therapy because of side effects."

Organizations including the American Society of Clinical Oncology believe the rise of cardiology-oncology clinics – U-M's is the first in Michigan – could have a great impact on treatment outcomes and patient care. A dedicated clinic has the potential to allow the safe completion of cancer treatment without significantly increasing heart risk.

Of course, not all patients undergoing cancer treatment experience heart damage. Those who should be considered for consultation in the University of Michigan Cardio-Oncology clinic include those who are newly diagnosed with cancer and also have, or are at risk for developing, heart disease; as well as those who have heart failure symptoms or are taking high doses of potential cardiotoxic therapies.

"By developing strategies to minimize cardiotoxicity, we can add years to a patient's life," says Leja.