The Vanderbilt Cardio-Oncology program has fostered a special collaborative relationship combining the expertise of cardiologists and oncologists to understand the effects of cancer therapy on the heart. This type of collaboration is now helping to define the cardiovascular health of more than 14 million cancer survivors in the United States.
With nearly 3 million breast cancer survivors, and even more surviving prostate cancer in the United States, preventing or managing their heart disease has significant public health implications.
“A dramatic increase of effective new cancer treatments has given us an enlarging group of cancer survivors,” said Michael Neuss, M.D., chief medical officer of the Vanderbilt-Ingram Cancer Center.
“Survivorship care is designed to address both the short- and long-term effects of these treatments. At Vanderbilt we are fortunate to have national leaders in this new area, including specific programs addressing the cardiac and neurologic consequences of cancer.”
The incidence of heart disease has increased in cancer survivors in part as a direct result of cancer therapy itself and can manifest in various forms. This is especially true for breast cancer.
“Heart failure can be caused by breast cancer therapy, especially anthracyclines or trastuzumab. We have also begun to appreciate radiation therapy for breast cancer as a significant risk factor for heart attacks in breast cancer survivors,” said Javid Moslehi, M.D., who recently joined Vanderbilt Heart and Vascular Institute (VHVI) as the director of Cardio-Oncology.
“Early and aggressive efforts to reduce cardiac risk factors through lifestyle modification or with medical therapy represent the most important intervention to prevent [cardiovascular disease in cancer survivors],” Moslehi recently wrote in an editorial for the New England Journal of Medicine.
Moslehi, who came to Vanderbilt from Harvard Medical School in Boston, is collaborating with oncologist Deborah Friedman, M.D., surgical urologist David Penson, M.D., interventional cardiologist David Slosky, M.D., and heart failure specialist Daniel Lenihan, M.D., to implement guidelines to prevent cardiovascular disease in cancer survivors.
At the heart of the guidelines is a simple concept that Moslehi refers to as ABCDE of cardiovascular disease prevention in cancer survivors: awareness, prophylactic aspirin; blood pressure control; cholesterol lowering, cigarette smoking cessation; diet, dose of chemotherapy, diabetes management; and exercise.
“These guidelines are going to be our platform for the Cardio-Oncology survivorship program here at Vanderbilt and is a simple way for cardiologists, oncologists and primary care physicians to address cardiovascular wellness in cancer survivors,” Moslehi said.
The cardiovascular health of cancer survivors will be a new focus of the National Comprehensive Cancer Network (NCCN), an alliance of 25 cancer centers in the United States whose goal is to advance the quality, effectiveness and efficiency of oncology care so that cancer patients can live better lives.
Moslehi and Friedman represent Vanderbilt in the NCCN clinical practice guidelines in oncology survivorship.
The cardiovascular wellness guidelines in cancer survivors, which Moslehi is chairing, will be released later this year and will help define specifics of cardiovascular care for cancer survivors.