Cardio-oncology: a new sub-speciality in South Africa
Cardiologist, Dr YT Singh, explains what cardio-oncology is and why it forms an integral part of a cancer journey.
What is cardio-oncology?
Cardio-oncology is a field in which a cardio-oncologist (a cardiologist who is familiar with the cardiovascular complications of cancer drugs and radiotherapy) works closely with an oncologist, in detecting and treating cardiovascular complications due to cancer drugs and radiotherapy.
The cardio-oncologist must be aware of the international guidelines and protocols pertaining to the follow-up and management of such patients.
Cancer therapy today has advanced greatly, resulting in cure of many cancers like breast-, prostate-, lung cancer, and childhood cancers e.g. Hodgkin and Non-Hodgkin lymphomas.
However, almost all classes of cancer drugs and radiotherapy, particularly to the chest, result in cardiovascular complications. The drugs affect not only the heart muscle, but also affect the heart valves, the vasculature and heart rhythm.
These complications can result in cardiac failure, heart attacks and angina, valvular heart disease and stroke. Cancer drugs affecting heart rhythm can result in life-threatening complications.
Shared risk factors
Cancer and cardiovascular disease are the two leading causes of death worldwide, including South Africa. The risk factors that are involved in cardiovascular disease also share a common association with cancer, e.g. obesity, smoking, cholesterol, diabetes, hypertension and alcohol abuse.
Many of these risk factors not only result in cancer. But when a cancer patient has these risk factors, the treatment of cancer has a worse outcome. It is thus imperative for the cardio-oncologist to detect these risks in cancer patients, to make sure that the patient who survives cancer with appropriate cancer treatment, doesn’t die from a cardiovascular problem.
Before, during and after cancer treatment
Managing cardiovascular problems in a cancer patient before starting cancer treatment is vitally important for optimal successful results from treatment.
During treatment, cardiovascular complications due to chemotherapy and radiotherapy are also common. It’s important for a cardio-oncologist to detect and treat these problems during treatment.
The follow-up of the cancer survivor after completion of treatment is imperative, because many of the cardiovascular complications arising from cancer treatment can occur after completion. For example, anthracyclines, aka ‘red devil’, can cause cardiovascular complications up to 10 years after completion of therapy.
Many of the childhood cancers, such as lymphomas, are now curable. However, what is frightening, is that childhood cancer survivors can present with cardiovascular complications 10 years earlier than their adult counterpart of the same age, who haven’t had cancer. So, a childhood cancer survivor can present with heart failure and ischaemic heart disease 10 years earlier than an adult of the same age, who hasn’t had cancer. Thus, it’s essential for childhood cancer survivors to be followed up by a cardio-oncologist at regular intervals, well into adulthood.
First Cardio-Oncology Centre in South Africa
The first Cardio-Oncology Centre in South Africa has been established at Netcare Umhlanga Hospital.
The first cardio-oncology society in Africa, Cardio-Oncology Society of Southern Africa (COSOSA), has also been established. The board members are Dr YT Singh (president), Dr Ines Buccimazza, a surgeon involved with breast cancer and endocrine surgery at the Inkosi Albert Luthuli Hospital, UKZN, and Dr Ria David, a medical oncologist practicing with the Rory Callaghan Group, in KZN. COSOSA is affiliated to the International Cardio-Oncology Society (ICOS).
COSOSA hosted its first Cardio-oncology meeting on 7th March in Durban, KZN. Dr Stephen Casselli, CEO of ICOS, and Prof Eric Harrison, a senior board member of ICOS and head of the Cardio-Oncology Unit, in Florida, USA, were guests of honour. Prof Sebastian Szmit, a cardio-oncologist in Warsaw, Poland, also attended and presented at the meeting.
It is important that all doctors, radiotherapists and nurses involved in cancer management be familiar with cardio-oncology. Cancer patients also need to be educated about cardio-oncology and why it is vital to have a cardio-oncologist assess their cardiac status before, during and after cancer treatment.
MEET THE EXPERT – Dr YT Singh
Dr YT Singh has been a cardiologist in Specialist Cardiology Practice for 34 years. He practises at Netcare Umhlanga, -St Augustine’s, -Alberlito and -Margate Hospitals. He has a special interest in cardio-oncology and has established
the Cardio-Oncology Society of Southern Africa (COSOSA).