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Starting early for success

With advice from the Cardio-Oncology Clinic, Jack Reher found a routine that made his heart strong enough to withstand a stem-cell transplant to treat his lymphona. (Photo: Scott Streble)

U cardiology and oncology experts team up to minimize heart damage in people undergoing cancer treatment

Early-stage cancer patients have become one of medicine’s biggest success stories, as the almost 14 million survivors in the United States would be happy to attest. But for many of them, another threat lurks in the background: heart disease.

An unwelcome after-effect of many chemotherapy and radiation regimes, heart disease is now the leading cause of death among cancer survivors.

Through its integrated cardio-oncology program, the University of Minnesota has taken aim at this problem with a full-bore range of research and treatment facilities geared toward the prevention and early detection of heart disease in cancer patients, and its physicians are helping patients already diagnosed with cardiovascular problems withstand cancer treatment.

“I see patients in remission who were treated 10 to 15 years ago and are completely unaware that they are at additional risk for developing heart problems, and I also see cardiac patients now facing cancer treatment,” says Suma Konety, M.D., M.S., an assistant professor in the University’s Cardiovascular Division and head of the U-affiliated Cardio-Oncology Clinic. “While a majority of the patients we see have developed cardiac problems during or after their cancer treatments, this clinic is also about prevention, screening oncology patients for early symptoms of heart disease and monitoring the highest-risk group.”

Suma Konety, M.D., M.S. (Photo: Richard Anderson)

Pulling through

Jack Reher, a Richfield, Minn., man with a rare form of non-Hodgkin’s lymphoma, had a tough cancer battle. He received a drug essential to treating his lymphoma but one that negatively affected his heart by causing cardiomyopathy. It left him ineligible for a stem-cell transplant.

Soon Reher was sent to Konety at the Cardio-Oncology Clinic.

“Dr. Konety was definitely unhappy with the health of my heart,” Reher says now. “She told me my heart had been weakened, and I needed to start a cardiac medication used to strengthen the heart muscle and a strict exercise routine to build up my strength.”

After a year of elliptical workouts, taking his medication, and close follow-up in the Cardio-Oncology Clinic, Reher learned that his heart function had improved to the point where he became a candidate for a stem-cell transplant, which he underwent last year.

“My cancer is now in remission, and my heart is doing just great!” says Reher. “Everyone at the clinic is so friendly and caring, and Dr. Konety always gives 100 percent. She really helped pull me through.”

Reher is not the clinic’s only success story. According to Konety, screening high-risk cancer patients has identified a number of people in the early stages of heart failure, valvular disease, coronary disease, or other vascular disease.

“Because they were still asymptomatic,” she explains, “they hadn’t yet triggered a cardiology alert. But that’s our focus here—to make an early diagnosis and promptly initiate treatment for heart disease.”

Who is high-risk?

Anthracyclines, a class of chemotherapy agents essential to the treatment of such diseases as breast cancer, leukemia, sarcoma, and lymphoma, have long been known to cause heart damage. And scientists continue to identify other chemotherapy drugs that can also lead to cardiac toxicity. Likewise, chest radiation (a treatment given to people who have Hodgkin’s lymphoma, breast cancer, and lung cancer) can cause heart damage.

“Patients who received both chemotherapy and radiation to the chest are especially at risk,” explains Konety. “And remember, heart damage may not be readily apparent for years after treatment.”

A wealth of resources

Konety credits the University’s strong cardio-oncology program to outstanding collaboration among University of Minnesota Physicians Heart, the Cancer Survivor Program, and the Masonic Cancer Center.

And now, with the June 2013 opening of the Cancer and Cardiovascular Research Building in the U’s burgeoning Biomedical Discovery District, Konety expects both research and care programs to make another leap forward.

“The key is recognizing cardiac dysfunction during all stages of cancer treatment and initiating therapy as soon as possible when appropriate,” she says, “because when we do that, we improve survival rates.”

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