THEN NOW NEXT
Cardio-Oncology
By Jill Stefancin
Photo: Marty Carrick
THEN
While chemotherapy is a lifesaving and effective cancer treatment, researchers and physicians have long recognized that it also may cause unintended damage to healthy cells. In the 1970s, oncologists began noticing that some patients treated with anthracyclines — highly effective cancer drugs — developed cardiovascular complications such as cardiac dysfunction and heart failure. When these issues interfered with cancer care, patients were referred to cardiologists, revealing the need for a more proactive approach to detect early signs of heart disease. By the 1980s, cardio-oncology had become a comprehensive field covering the entire spectrum of cardiovascular issues in cancer patients.
NOW
Today many cancer treatment plans include cardioprotective measures: treatment strategies aimed at reducing someone’s risk of heart attack, stroke, heart disease or death related to heart damage. Lifestyle changes such as exercise may be recommended, especially for cancer survivors with excess weight. Cancer survivors whose cholesterol or blood pressure is high may be prescribed drugs like statins to lower overall cardiovascular risk. Or cancer treatment plans could be adjusted — for example, choosing a less aggressive therapy to lower the risk of heart damage. Every cancer patient needs their own uniquely tailored combination of these cardioprotective treatments, but determining the most appropriate combination of treatment options is a complicated, time-consuming process. Current monitoring relies on regular heart ultrasounds, which often detect heart damage after it has already occurred. Better tools could help doctors to identify high-risk patients early, when protective interventions are most effective.
NEXT
A research team led by Feixiong Cheng (pictured), PhD, Director of the Cleveland Clinic Genome Center and holder of the Dr. Keyhan and Dr. Jafar Mobasseri Endowed Chair for Innovative Research, is developing a smart calculator that helps doctors assess heart failure risk in cancer patients receiving chemotherapy. The calculator uses artificial intelligence to analyze information that doctors already routinely collect, like blood test results, heart ultrasound measurements and basic patient information, to give each patient a personalized heart risk score. This AI calculator is transformative for cancer patients: High-risk patients will receive intensive cardiac monitoring and early cardio-protective interventions, while low-risk patients avoid unnecessary testing. Each cancer survivor will receive appropriate cardiac care based on their individual risk, preventing heart damage during lifesaving cancer treatment. Thanks to seed funding from a Cleveland Clinic Catalyst Grant, the research has expanded into a large-scale project with external funding.