Jamie Lewis (Host): Have you heard of cardio-oncology? It's a relatively new field and it's changing the way cancer patients and survivors receive treatment. Today, on the FirstHealth and Wellness Podcast, we'll be talking with Dr. Rony Shammas, a clinical and interventional cardiologist who will share his expertise about cardio-oncology and the ways it changes the health and lives of patients and survivors of cancer. This is the FirstHealth and Wellness Podcast from FirstHealth of the Carolinas. I'm Jamie Lewis. Dr. Shammas, we're glad you're here. Thank you for joining us.

Dr. Rony Shammas: Thank you, Jamie, for having me today to briefly discuss this important topic.

Host: Of course. Now, cardio-oncology is a fairly new field in medicine. Can you tell us how it helps patients and impacts their treatment plans?

Dr. Rony Shammas: As you may know, cardiovascular disease and cancer are the first and second leading cause of death in the United States. And some cancer therapies may have serious side effects, cardiac side effects, such as heart failure, irregular heart rate, heart attacks, and even sudden cardiac death. And some patients with cancer are at especially high risk for such events.

The cardio-oncology service shifts the role of the cardiologist from just treating cardiovascular complications of cancer therapy to focusing on prevention, early diagnosis, and early intervention in a dedicated and patient-centric environment. The key goal here is to enable cancer patients to receive the best cancer therapy at the lowest possible cardiovascular risk while minimizing disruptions or delays of their cancer treatment. In other words, the hope here is to eliminate cardiovascular disease as a barrier to effective and, many times, curative therapy in cancer patients. And to ensure that these patients are followed up long-term beyond their cancer treatment and initial diagnosis to help improve the quality of life and reduce the burden of cardiovascular disease for the survivors, we believe that a well-integrated service will hopefully avoid or at least minimize fragmentation of care, leading to a more cost-effective and better quality of care for these patients.

Host: Now, doctor, how have you seen this positively impact your patients so far?

Dr. Rony Shammas: So as you initially said, cardio-oncology is a new and it's a growing field. By optimizing cardiovascular health and any pre-existing cardiovascular disease using guideline therapy, and by defining optimal surveillance and prevention for each individual patient, more patients have been able to complete their cancer treatment successfully and with less side effects. The early diagnosis, prevention, and early intervention that this service provides has been associated with improved outcomes and better quality of life.

Host: Who are the patients that are most likely to benefit from this integrated service?

Dr. Rony Shammas: This is a great question. In general, the higher the risk of the patient or the risk of the cancer therapy they are receiving, the more impact this service will have. There are few groups who stand to benefit the most from such a service, and I'll try to go over some of them.

First are patients receiving high-risk cancer therapy. Some treatments are more cardiotoxic than others. Then, there are patients who are themselves high risk for complications related to their treatment, such as those who have pre-existing heart disease, or who have received prior chemotherapy or radiation therapy, older patients, and patients who have multiple cardiovascular risk factors, such as hypertension, smoking, diabetes.

The third group would include those who develop symptoms suggestive of cardiac dysfunction, or those who remain asymptomatic, have no symptoms but show early signs of cardiac side effects upon surveillance testing, such as when we do echos or cardiac MRIs or get lab work done on surveillance. This group, the one that we just mentioned, is a particularly important group that is poised to benefit from such integrated service.

Another group is those requiring pre-op cardiac evaluation prior to a time-sensitive cancer surgery. The presence of functioning, well-integrated cardio-oncology service can avoid delays for pre-op workup for these patients.

Finally, let's not forget about the cancer survivors, a rapidly growing population thanks to advanced cancer therapies. These patients will benefit from long-term follow-up in the cardio-oncology clinic to assure a very safe survival without impairment from cardiovascular disease after beating cancer.

Host: What else should people know about the future of oncologists and cardiologists working together?

Dr. Rony Shammas: Cardio-oncology is a multidisciplinary specialty. The foundation of a successful program is for everyone to partner and to work together to achieve the goal of ensuring cardiovascular health and safety while allowing the patients to continue their cancer treatment. There are many shared mechanisms between cancer and heart disease, including some genetic pathways and also some common risk factors such as advanced age, alcohol consumption, obesity, smoking, and sedentary lifestyle. So, cardio-oncology services must be viewed as a complementary effort between two specialties to combat two of the biggest killers, cancer and heart disease, in a coordinated and cost-effective way.

Host: Dr. Shammas, thank you so much for being on the podcast. It's been really informative.

Dr. Rony Shammas: Thank you so much, Jamie. Have a great day.

Host: Thank you for listening to this episode of the FirstHealth and Wellness Podcast. I'm Jamie Lewis. If you found this helpful, please be sure to share it with others on your social channels. And for more information on the exciting field of cardiac oncology, please visit firsthealth.org/cancer.