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Cardio-Oncology Gets to the Heart of Cancer Patients' Health

Cedars-Sinai experts in the Smidt Heart Institute are making heart health a priority for cancer survivors and patients through the Cardio-Oncology Program.

The program is more relevant than ever because cancer patients are living longer than ever. The five-year relative survival rate for all cancers combined has increased substantially since the early 1960s, from 39% to 70% among white patients and from 27% to 64% among African American patients.

But with an uptick in longevity, many cancer survivors are faced with additional health concerns, including heart failure.

"Cancer patients with lymphoma, sarcoma, leukemia or breast cancer may receive anthracycline-based chemotherapies or immune checkpoint inhibitors or radiation," said Balaji Tamarappoo, MD, PhD, associate director of the Biomedical Imaging Research Institute at Cedars-Sinai. "Even in small doses, these lifesaving regimens present risks and may cause injury to the heart. That's why cardio-oncology is such a critical component of cancer care."

Experts in the Cedars-Sinai Cardio-Oncology Program, including Janet Wei, MD, and Michele Hamilton, MD, work alongside oncologists to encourage heart monitoring before, during and after cancer treatment.

"Oncologists should continue doing their critically important work of helping a cancer patient live and thrive," said Tamarappoo. "But cancer patients also need to know that if they are receiving treatments like anthracycline or immune checkpoint inhibitors or radiation, our team can help keep their heart healthy."

In 2004, Deborah Murry, then 46, learned she had breast cancer. To save her life, her Cedars-Sinai oncologist recommended five cycles of anthracycline. The treatment worked, putting Murry's disease in remission for over a decade.

Balaji Tamarappoo, MD, PhD
Even in small doses, these lifesaving chemotherapy regimens present risks and may cause injury to the heart. That's why cardio-oncology is such a critical component of cancer care.
Balaji Tamarappoo, MD, PhD

So, when she learned her disease returned in 2018—this time as triple negative breast cancer—Murry immediately looked to her care team for the next steps in her treatment. Her heart health was not on her radar. But after four more cycles of anthracycline and enrollment in a clinical trial with an immune checkpoint inhibitor, Murry developed chest pain. An ultrasound of her heart showed her cardiac function was mildly reduced.

"I was in shock," said Murry, whose breast cancer has since gone into remission. "I couldn't believe that after overcoming cancer for a second time, something was wrong with my heart as a result of my cancer treatment."

After meeting with Tamarappoo and experts in the Cedars-Sinai Cardio-Oncology Program and undergoing several diagnostic tests, Murry began taking medication to prevent heart failure progression. One year later, she no longer has cardiac symptoms, and her heart function has improved significantly.

"My shock quickly turned to ease thanks to the quick attention of my care team and their diligence in diagnosing my irregular, but consistent, chest pain," said Murry. "From the bottom of my now healthy heart, I'm so very grateful for this excellent team."

Read more in Discoveries: Of Hearts and Hormones