Cancer programs add cardio-oncology services

Published on Monday, November 11, 2019

By: Cynthia Wall

The cancer therapy that helped him gain remission left Fred Robertson with congestive heart failure, placing him among cancer patients nationwide whose cancer therapy, though successful, left another problem.

“Chemo or heart failure?” he asked recently. “It’s not a good choice.”

Robertson and others like him are the focus of cancer and heart specialists at the University of Mississippi Medical Center. Working together, the UMMC Cancer Center and Research Institute and University Heart, have created a cardio-oncology program at Jackson Medical Mall, home of the CCRI outpatient clinics.

“This is offered by a handful of cancer centers,” said Dr. John Ruckdeschel, CCRI director. “It’s a relatively new problem.”

Dr. Craig Long, associate professor of medicine, who helped establish the program said members focus on:

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  Patients who have cardiac issues when they are diagnosed with cancer. “These can be ongoing issues or a history of cardiac disease that might impact their oncologic care,” he said.
• Patients who have risk factors for cardiac disease that need to be managed.
• Patients who are receiving cancer therapy that is potentially cardiotoxic. “We can help monitor them and intervene as indicated,” he said.

Some treatments used to fight cancer, including some chemotherapies, immunotherapies, targeted therapies and chest radiation, may harm the heart.  By using echocardiography, or an ultrasound of the heart also called an echo, the teams can monitor heart function and status.

Ideally, said Dr. Brandon Lennep, an advanced heart failure/transplant cardiology fellow, if doctors know the therapy may affect the heart, they can order a baseline echo before treatment begins and at intervals during treatment. If the echo reveals a problem, doctors have a chance to alter cancer therapy.

The field is new, said Lennep and learning about new drugs and possible side effects is ongoing.

Eventually, he said, he hopes to participate in research at UMMC that helps advance the field. “This is going to be a fruitful field in cardio oncology,” Lennep said.  

Long agrees. “It also will provide opportunities for research on this unique patient population who have typically been excluded from cardiovascular clinical trials,” he said.

Long said Lennep completed his general cardiology fellowship and spent a month at Washington University in St. Louis working in its cardio-oncology clinic. Lennep “is the person from the cardiology side to get this clinic up and running.” He’ll join the faculty in July 2020.

Ruckdeschel said the CCRI has added cardio testing into its electronic health record.

“So if a patient is to receive a drug that has possible heart effects, the provider will get an automatic reminder to order a basic echocardiogram,” he said.

Having the echo services at JMM means patients no longer have to visit the Pavilion. That often meant a separate appointment and separate day for many, said Ruckdeschel, and some simply didn’t show up.

 “The keystone is we are trying to be sensitive to travel demands placed on cancer patients,” Lennep said.

The ability for doctors to get answers quickly helps too, Long said. For example, he describes a patient who had a cancer question. “I walked down the hall and got Dr. (Stephanie) Elkins,” he said. Ekins, who heads the Division of Hematology and Oncology, is a longtime hematologist.

“She saw the patient and answered the question. All in one room. This doesn’t happen too often if cancer and cardiology aren’t working together.”

Robertson’s wife, Sue, likes the convenience of having oncology and heart visits coordinated and on the same day. That makes travel and appointments easier for her and her husband, who taught economics at Hinds Community College campuses in Raymond and Pearl for more than 45 years.

The Robertsons, who recently moved to Terry, have been coming to UMMC for therapy for his acute myeloid leukemia since November, 2018. Sue especially likes the convenience of having heart services at the cancer clinics so they don’t have to navigate parking and offices on the main campus.

“It’s nice to have all the appointments here and it’s easier to get in and out,” she said of the JMM clinic.