A collaboration between two distinctly different UPMC specialties is helping cancer patients undergoing chemotherapy treatment avoid damage to their hearts.

One of the first centers of its kind to offer heart and vascular care to people currently undergoing cancer treatment, the UPMC Center for Cardio-Oncology is a partnership between the UPMC Heart and Vascular Institute and UPMC Hillman Cancer Center.

Traditional and novel chemotherapy agents can damage the heart or peripheral blood vessels, or cause problems with clotting or blood lipids. Some serious cardiovascular effects occur while the chemotherapy is being administered; others appear long after cancer has become a distant memory. The cardio-oncology team works to prevent, diagnose, and treat heart and blood vessel issues as they arise in cancer patients and survivors.

Combining Services

At the UPMC Center for Cardio-Oncology, cardiologists partner closely with medical oncologists to follow patients being treated for cancer to prevent negative cardiac effects. Chemotherapy can cause a number of problems, including hypertension, arrhythmias, heart failure, and premature coronary artery disease (CAD).

“Each cancer and each cancer treatment has a unique set of complications,” says Joshua Levenson, MD, a cardiologist and the director of the UPMC Center for Cardio-Oncology. “For example, we know that some chemotherapy for breast cancers and lymphomas can damage the heart, some immune therapies can inflame the heart, and that men having prostate cancer treatments are at an increased risk of heart attack. So, we can prevent chemo from reaching the heart and monitor symptoms to prevent adverse effects. We tailor our cardiology management to the individual patient.”

By teaming up with experts from UPMC Hillman Cancer Center, the UPMC Center for Cardio-Oncology offers a unique treatment approach that:

  • Assesses the risks of heart disease based on cancer type, treatment, history, and other factors.
  • Uses state-of-the-art 2-D and 3-D echocardiography, including myocardial strain assessment, to track changes or effects of cancer treatment and predict those who may be at higher risk of cardiotoxicities.
  • Works directly with cancer doctors to design treatment plans for patients that lower the risk of heart disease while effectively treating the cancer.

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Helping the Chemo to Cure

The center often confers on long-term cardiology patients who have received a new cancer diagnosis, which makes for a more complicated cancer treatment regimen. That includes people with adult congenital heart disease (ACHD), meaning their heart issues were present at birth, since patients with ACHD are at increased risk of developing cancer, the same way patients who had cancer in their childhoods are at increased risk of developing heart problems later in life.

Working together with oncologists in the community, the center helps patients who are having cardiac complications from their lifesaving chemo medication. For example, Dr. Levenson was brought in to help a patient who started to have symptoms of heart disease after receiving immunotherapy to treat their cancer. “We recognized the issue, put the patient on a heart pump with immune suppression, and now they are doing great,” he says. “Without cardio-oncology intervention, the patient would have died from the heart damage before they even had a chance to realize any curative effects of the immune therapy.”

Doctors at the center also see patients who have developed heart problems years after having cancer treatment, such as those treated for Hodgkins lymphoma, which can cause long-term effects on the heart. “We can counsel physicians to avoid the need for heart surgery for their patients in favor of stents because prior radiation increases the risk of complications for this population of patients,” Dr. Levenson says.

Another group of patients treated at the UPMC Center for Cardio-Oncology are those with advanced cancers. “Oncologists often have a dilemma when treating patients with metastatic cancer and heart disease because they may feel that the person is too sick to undergo chemotherapy,” he says. “We’ve found that a lot of patients with advanced cancers die from heart issues, not the cancer. We can help improve the heart symptoms to provide a more meaningful life for the person for the time they have.”

Expanding Cardio-Oncology Consults

The COVID-19 pandemic accelerated the use and acceptance of telemedicine in patient care, which has enabled the UPMC Center for Cardio-Oncology to consult on complex cases across the country and offer clinical trials to a broader patient population.

“Because we understand all the different cardiac scenarios that can present during cancer treatment, we can help oncologists anywhere when they have a patient in trouble,” Dr. Levenson says. “If an oncologist has a patient who is actively dying, through telemedicine we can use existing imaging, lab work, and the patient history to make recommendations. That way, the patient can stay in their local hospital without having to drive or fly to Pittsburgh and still receive our expert specialty care.”

The UPMC Center for Cardio-Oncology represents a major philosophical difference in the cancer treatment of patients with heart issues. “Patients with heart problems and cancer often are undertreated for both issues because doctors may be afraid that the patient cannot withstand the standard treatment. Our goal is to successfully treat both issues at the same time.”

“We understand diabetes and heart disease and how they interplay with cancer and cancer treatment,” Dr. Levenson says. “If a physician has a complex cancer patient with cardiac issues, we can really help if we get involved early, allowing the oncologist to treat the cancer more aggressively.”

Contact the UPMC Center for Cardio-Oncology

To learn more about the UPMC Center for Cardio-Oncology, visit our website.

About Heart and Vascular Institute

The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine.

About UPMC Hillman Cancer Center

UPMC Hillman Cancer Center provides world-class cancer care, from diagnosis to treatment, to help you in your cancer battle. We are the only comprehensive cancer center in our region, as designated by the National Cancer Institute. We have more than 70 locations throughout Pennsylvania, Ohio, New York, and Maryland, with more than 200 oncologists. Our internationally renowned research team is striving to find new advances in prevention, detection, and treatment.