Scott Webb (Host): For people who are being treated for cancer, there are inherent concerns about cardiovascular health during and after cancer treatment. And joining me today is Dr. Besiana Liti. She specializes in non-invasive cardiology and cardio-oncology, and she's here today to tell us more about the cardio-oncology program at The Elliot and how this multidisciplinary team of cardiovascular and cancer experts works together for the best patient experiences and outcomes.

This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Doctor, thanks so much for joining me today. We're going to learn about cardio-oncology. Now, I know what cardio is, and I know what oncology is, and we're putting those two words together. So, I have a sense of what you're going to tell us, but it is great to have your expertise to learn from you today. So, let's start there. What is cardio-oncology?

Dr. Besiana Liti: Cardio-oncology is a new subspecialty within the greater realm of cardiology. And it came about not too long ago once we started to understand the needs of patients with cancer undergoing treatment, and the complications that arise from said treatment during and after, especially, obviously, cardiovascular complications.

Host: That's perfect. And I want to give you a chance here to share with us, share with listeners, sort of the inspiration behind starting the Cardio-Oncology Program at Elliot Hospital.

Dr. Besiana Liti: So, at Elliot Hospital, there's a very robust oncology program, as a few folks in the area may know. And so, essentially, there was this vacuum in terms of taking care of these oncology patients from a cardiovascular standpoint, specifically tailored to their needs as oncology patients. And so, that's where the inspiration came from, and that's why I joined Elliot Hospital to bring this new expertise to the team, to their cardiology team, and be able to help these patients.

Host: Yeah, team for sure, patient-focused. And wondering with that in mind, what are some of the unique challenges faced by cancer patients when it comes to cardiovascular health, and how does the Cardio-Oncology Program aim to address these challenges and improve patient outcomes?

Dr. Besiana Liti: So, the first challenges really are timing, right? These patients are going through a lot, so trying to get them to yet another doctor's appointment sometimes can be a big obstacle for them, especially if they're having side effects of their chemo treatments. So, one of the aims of the program is to actually bring the expertise to them. In other words, we are trying to set up this clinic at the Oncology Center at The Elliot so that the patients don't necessarily have to make special appointments or separate appointments if they need help right away, and we can start that process right away.

The other challenges obviously have to do with their prognosis and, generally speaking, what they're wanting to do and also what their aims, their goals are in terms of their treatment and afterwards. So, it is important to actually sit down and have a thorough discussion with them and their families a lot of times to be able to bring their wants and needs alongside the options for treatment so that we can actually achieve their goals.

Host: Yeah, I love that. The old paradigm in medicine was you come where we are, we'll be over here and you come over here. But it seems now more and more that the focus being so much on patients, especially at The Elliot, is bringing the things that folks need to them as much as you can and making it easier, more efficient, sort of a one-stop shopping, right?

Dr. Besiana Liti: Absolutely. So, the idea being that if you facilitate the care, if you make it less cumbersome, especially for someone who's already going through oncological treatments, generally speaking, there's going to be better outcomes, and it's easier for patients to adhere to their recommendations without having to do, you know, extra work or maybe an extra trip. And honestly, I think that these folks are already going through enough, so whatever we can do to simplify their lives, that's what we're here to do.

Host: So, what types of services and treatments, we're thinking about patients and what they need. What types of services and treatments does the Cardio-Oncology Program offer to patients?

Dr. Besiana Liti: So, it's a comprehensive program, essentially starting from the initial consultation and then proceeding all the way to imaging, advanced imaging, as well as treatment, both invasive and non-invasive. The way that the program is set up is that, first, we have to find out what the exact nature of the problem is, obviously. And then, we proceed with what the necessary testing may be.

What we are also working on is bringing advanced imaging to The Elliot through coronary CTA through cardiac MRI. These are obviously options that are not available everywhere, but having them in-house makes it so much easier to be able to identify the problem. And then, of course, once you identify the problem, that you know how to treat it.

Host: Right. And I just love learning about sort of these multidisciplinary teams and teams of experts working together. So, I'm interested to learn more about the collaboration between oncologists and cardiologists, and when you folks all work together. How does that really benefit patients in this program?

Dr. Besiana Liti: I mean, that is a perfect question because, honestly, that is really the core, the heart of this program, is the ability to collaborate with oncology and the ability to provide patients with both sides of the expertise. Truthfully, you know, a true cardiac-oncology program would be a multidisciplinary program. In other words, you know, there are times where things are not as straightforward as they are with general cardiology in a way. So, you actually have to sit down with your oncology colleagues. You have to discuss the patient, and you have to have these multidisciplinary kind of board meetings to decide, do we continue with the treatment? Do we have other options? What are the options that we have from a cardiovascular standpoint to help with the side effects? And obviously, you know, more minds than one are always better.

Host: Sure. Yeah, I love that. It sort of makes me think about, you know, and I've watched a medical TV shows that all the folks would be familiar with, when the team of experts gets together and they talk about a particular patient, right? And they sort of spitball a little bit, and they try to figure out, okay, what's the best course of treatment? What do we do next? I don't know that it's quite like a TV show in your experience, but maybe you could take us through that, like one of those meetings where you're talking about a particular patient.

Dr. Besiana Liti: Yeah, it's not quite as dramatic. But there's definitely a lot of scientific discussion. And I have had situations where patients were obviously very much affected by their oncology treatments in terms of heart function. In particular, a patient comes to mind who developed severe heart failure with one of the immune checkpoint inhibitors. And unfortunately, it did not work for him, even though in terms of the cardiovascular complications, it was working for his cancer. So, we actually had to have a meeting. And after obviously treating the acute problem in terms of the heart failure, putting him on the correct medications, we had to have a meeting about what is our next step? You know, what other drugs are available? How do we mitigate the risk of this happening again? And just looking at him as a whole in terms of his risk factors. He was in fact able to go on a different treatment and has been cancer-free now for a few years, and just undergoing, you know surveillance imaging. But it was one of those situations where just having his entire team come together and come up with a plan really benefited him in the long term.

Host: Yeah. Well, that brought a big smile to my face. I love hearing that. And wondering, when we think about preventative care, like what role does that play in the Cardio-Oncology Program, especially for patients who are undergoing cancer treatment?

Dr. Besiana Liti: Yeah. You know, we always focus on the patients that are undergoing cancer treatment, but we cannot forget a huge amount of patients who have already completed cancer treatment. So, prevention is not just prevention at the time of cancer treatment. You can also do prevention after cancer treatment. The truth is that cancer treatment can be associated with a lot of cardiovascular complications, including valvular complications, coronary disease, peripheral vascular complications, besides heart failure. And so, we have a large cohort in this country of childhood survivors of cancers who may not even be aware that even 10, 15 years down the road, they still remain at higher risk than the general population of developing cardiovascular complications at a younger age.

So, prevention really doesn't just start at the time of chemo treatment. It actually can be done at any point. And that includes, you know, obviously, best practices in terms of exercise, in terms of diet, in terms of looking at family history, personal risk factors, also doing some baseline workup in terms of personal risk factors such as smoking, obesity, diabetes, et cetera. All of those play a factor in how someone is going to do in the long term, not just with cancer, but even without it. So really, I would say prevention is at the core of things. And we really want to do that instead of having to treat.

Host: Right. Always easier, always more efficient, and better for patients to prevent these things before they happen rather than treating after the fact, of course. So, how does the Cardio-Oncology Program tailor its approach to meet individual needs of each patient? You talked about experts getting together and just, you know, discussing patients and their cases and treatment and all of that. But what are some of the other ways that you meet the individual needs?

Dr. Besiana Liti: Well, essentially, we look at their lifestyle. We look at their goals. We look at how they envision their life, you know, in the short term and in the long term. We look at the prognosis. We have honest discussions. But I've said before that I am a huge proponent of patient autonomy. In the end, it is the patient who drives the train, so to speak. And as much as we want to offer treatment, sometimes aggressive, sometimes not. But as much as we want to offer that, we also need to listen to the patient to see what they're willing and what they want to do and try to explain to them in simple terms, what every option, every choice means to them in terms of, you know, even as we treat the cardiovascular complications, there can be complications even from that. In other words, we have to give them a broad view and understanding in simple terms of what it means and also listen to what they want to achieve, what their goals are.

Host: Yeah, that's awesome. I just want to finish up, doctor. What advice would you give to cancer patients who are concerned about their cardiovascular health during treatment?

Dr. Besiana Liti: Well, I would say to have an honest discussion with their oncologist or their mid-level provider, their nurse practitioner, whoever their primary provider is, even with their primary care providers for that matter. And just kind of have an honest discussion about what their personal risk factors are, what their family risk factors are, what they're concerned about the most, and also trying to understand what type of chemotherapy they're on or what type of treatment they're receiving.

Obviously, not all treatments lead to cardiovascular complications, so some may be perfectly safe. But even if you're taking a treatment that is not necessarily associated with high cardiovascular complications, you yourself may have risk factors for cardiovascular disease separate from the treatment. So, having that discussion about looking at your risk factors, your family risk factors, overall your lifestyle, is the first step. And then if your provider, your primary care, your oncologist, or whoever you're having this discussion with feels that you would benefit from further input from a cardiologist, not just a cardio-oncologist, but any cardiologist in general, that would be a good starting point. Obviously, you know, preventative care in cardiology is kind of at the core, the fundamental of what we do, and that can be done at any point.

Host: Right. Yeah, as you said earlier, prevention is key as much as we can. And great today to learn more about the Cardio-Oncology Program at The Elliot, and learn more about what you do and how you do it and the multidisciplinary team. Good stuff. Thank you so much.

Dr. Besiana Liti: Thank you very much for your time.

Host: And for more information, go to the Elliothospital.Org and search Cardiology. And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.