Maggie McKay (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

I'm your host, Maggie McKay. Today, I'm sitting down with Cardiologist, Dr. Kristopher Swiger, and we're going to be discussing heart health and cancer. Before we get started, I would love to know how cardiology became a passion of yours. What made you become a cardiovascular disease specialist?

Dr. Kristopher Swiger: Yeah, thank you Maggie for having me. I'm one of those kind of weird people who knew from middle school what I wanted to be and never really strayed from that. Part of it's, I had two grandparents that passed away in their forties from heart disease.

So cardiovascular disease was always sort of part of the history and story of my family. It's something I've been interested, you know, as I said, from a young age. And then when I got into training, I realized, I actually really enjoyed working with oncology patients. So I'm a cardio oncologist, so I'm a weird cardiologist who primarily works with patients, who are receiving treatment or fighting cancer.

And I just really enjoyed kind of the passion and dedication that oncology patients have to tackling their disease. So that's how I ended up in this relatively niche field.

Host: I'd like to better understand what you treat. Do you strictly see patients who are undergoing cancer treatment?

Dr. Kristopher Swiger: So I see them at any step of their cancer journey. So I see some patients before they receive treatment, people who have preexisting risk factors or cardiovascular disease to make sure they're sort of tuned up and educated and ready to go. I see people who experience issues during treatment, and then I follow patients who are in the survivorship phase, so for years after they treat their cancer and there's no evidence of their cancer remaining.

Host: What type of impact does chemotherapy have on a patient's heart?

Dr. Kristopher Swiger: So it used to be relatively simple. We had a somewhat limited kind of arsenal of medications to fight cancer. And there were two in particular, that we've known about since the 80s and 90s that would directly damage the heart muscle, weaken the heart, and sometimes cause what we call heart failure, which is just your heart's inability to keep up with what your body needs. But it's become much more complicated and that's why this field of cardio oncology now exists because we're in this sort of renaissance of cancer therapeutics.

We have something like 80 targeted therapies that we didn't have 10 years ago, and they're rapidly coming on to the market, being approved by theFDA and we're learning about the ways they affect the heart in real time. So it's far beyond heart failure now. These medications can cause arrhythmias. They can cause, clots. They can affect, uh, patients blood pressure and diabetes. And so it's really kind of the full spectrum of cardiology now, and how we kind of help these folks.

Host: How long has cancer and cardiology been studied side by side?

Dr. Kristopher Swiger: I mean, there are cancers that do go to the heart, but they're very rare. Far more often it's the sort of systemic effects of the cancer, the inflammation, the debilitation, and then the treatment effects as well that can impact the heart. This field began, technically the 70s with a drug class called anthracyclines, but it really kind of has blown up in the last 5 to 10 years, concordant with all these new treatments that we have.

Host: Dr. Swiger, can you tell me about why you have patients go through cardiac rehab?

Dr. Kristopher Swiger: Sure, cardiac rehab is not a new concept, but it is a relatively new concept for cancer patients. And so for anyone who's had a heart attack or open heart surgery for over 10 years, we've recommended cardiac rehab because we have great data to support it. We've recently here at the coast for the last four years, but in other places for much longer have been applying this to cancer patients as well, because the principles are the same. Cardiac rehab in its structured form really helps patients feel better, increase their physical endurance.

There's even some data for cancer patients that cardiac rehab can help them live longer and even prevent recurrence of their cancer. Essentially what this is, is we recognize both cancer and cardiovascular societies that cardiac rehab really benefits patients going through treatment. It helps them feel better objectively and subjectively. Objectively meaning we can measure their fitness and they do much better at the end of the program compared to the beginning. For the last four years or so, we've been trying to recommend this to anyone going through cancer treatment.

Host: Is this program designed to occur before, during, or after cancer treatment?

Dr. Kristopher Swiger: At any stage. Sometimes we do it beforehand to, particularly for patients who need some prehabilitation to get ready, say, for surgery to remove the tumor. And the surgeons really appreciate that we can get people into shape heading into surgery because they'll do better. People feel fairly poor, generally going through chemotherapy and this can help them feel better.

But the most common approach is to finish treatment and then try and recover. And we view this as a vital part of recovery.

Host: What are the reactions patients have to this type of program? Have you seen success?

Dr. Kristopher Swiger: I mean, if you measure success in exuberance, then it's been a slam dunk. The people that go through this program are passionate advocates and spread word kind of everywhere. We do look at measures of physical fitness before and after, and have shown of course that people do much better.

But I think getting back to what I just said, the most important thing is just that people feel that it makes a huge difference in their well-being.

Host: I can imagine once you're diagnosed, that would be motivation to get in shape, like you said, before surgery and, maybe after it all goes well and you're feeling okay. How do patients sustain a focus on their heart health once their treatment concludes?

Dr. Kristopher Swiger: Yeah, it's very difficult. There is this period of time after treatment ends, that we worry about. We call this sort of lost in transition period where your, your cancer hopefully is gone and you need to sort of refocus on all the other competing risks in your life. The primary usually being cardiovascular disease in part because cancer affects folks who are older, more likely, but also cardiovascular disease and cancer are sort of competing causes of death for all of us. So there is this kind of transition back to primary care, back to cardiology. I do like to follow folks in this survivorship period to ensure that their cardiovascular risk factors are controlled, to ensure that we're screening and looking for early signs or evidence of heart failure. 

But it is a challenge, right? You want to do a victory lap after you complete treatment, and I'm always sort of the nagging guy saying, yeah, what about your blood pressure? What about your exercise? But you know, the intent is to help people launch from completing cancer treatment to get back to their quality of life they had before.

Host: And in closing, is there anything else you'd like to mention that we didn't cover?

Dr. Kristopher Swiger: I think I would just say if you're going through cancer, you've been diagnosed, you're going through treatment and you're worried about your heart, just talk to your oncologist. They're the captain of this ship and your closest partner in defeating cancer and just ask them if there's anything you need to be worried about with the treatment or with your heart in general, and we'll be happy to help.

Host: Thank you so much for making the time to share your expertise. This has been so helpful and educational. We appreciate it.

Dr. Kristopher Swiger: Yeah. Thanks for your time as well.

Host: Again, that's Dr. Kristopher Swiger. To find a physician, visit NovantHealth.org. For more health and wellness information from our experts, visit HealthyHeadlines.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay, thanks for listening to Meaningful Medicine, a podcast from Novant Health.