Scott Webb (Host): There's a vital connection between heart health and cancer care, and today I'm joined by two experts in the field to explain the connection and share how their respective teams work together on behalf of patients to assess and minimize cardiovascular risk in cancer patients. I'm joined today by Dr. Eleonora Teplinsky, Head of Breast and Gynecologic Medical Oncology Valley Mount Sinai Comprehensive Cancer Care, and I'm also joined by Dr. Kariann Abbate. She's the Director for the Center for Comprehensive Heart Failure Care at the Valley Hospital, and she's the Associate Director of the Cardiovascular Service Line with the Valley Hospital.

 Welcome to Conversations Like No Other: Heart Care, presented by the Heart and Vascular Institute of Valley Health System in Paramus, New Jersey. Our podcast goes beyond broad everyday cardiac topics to discuss very real and very specific subjects that impact your heart health. We think you'll enjoy our fresh take. I'm Scott Webb. Thanks for listening.

It's really nice to have you both here today. We're going to talk cardio-oncology and combining those things and what does that mean for folks. And great to have you here. Great to have your expertise. Dr. Teplinsky, I'm going to start with you. Maybe the most basic one, what is cardio-oncology and why is it such an important field today, especially for women with breast and gynecologic cancers?

Eleonora Teplinsky, MD: You know, cardio-oncology is really the study of taking care of the heart after someone is going or has gone through cancer treatment. And we know that cancer treatments can impact the heart in various different ways, which we'll talk about.

Host: Mm-hmm.

Eleonora Teplinsky, MD: And you know, in breast cancer and particularly despite the growing rise of breast cancer, heart disease does remain the leading cause of death in women and so many of the risk factors for heart disease also increase the risk for cancer. So there's significant interplay, you know, even at diagnosis. And then a lot of the treatments that we give can impact the heart. And so this is why we really need a field that is focused on addressing our patients and supporting their heart throughout their lifespan.

Host: Yeah. And Dr. Abbate, I know that some cancer treatments can affect the heart, right? So maybe you can explain how that happens and what patients need to know about these risks.

Kariann Abbate, MD: So in the breast cancer space, there's two categories of treatment that can impact the heart. One is the anthracycline-based therapies that are often used to treat breast cancer. And in the past we thought that the damage that this medication class can cause was irreversible. But we're finding with our newer cardiac treatments that we actually can impact the heart in a positive way, even if we have seen some deleterious effects on the heart from the anthracycline medications. There's another class of therapy called HER2/neu medications that are used to treat breast cancer and they can cause the heart to weaken when they get the chemotherapy, but thankfully, with this class of medications, it's transient. So once the medication is finished or completed, the heart will return to normal.

But the good news is we do have heart strengthening medications that we can prescribe to patients while they're receiving these therapies to mitigate or to reduce the risk of impacting the heart with these chemotherapeutic agents.

Host: Yeah, I was thinking to myself, listening to you there that I wonder if they have heart strengthening medications, and of course you answered that question, which is why it's great to have experts here and Dr. Teplinsky who's most at risk for heart complications during or after cancer treatment. And are there signs or symptoms patients should be watching out for?

Eleonora Teplinsky, MD: Absolutely, and I think to add to what Dr. Abbate said, you know, in addition to anthracyclines and the anti HER2 targeted therapies, more and more we're learning about cardiovascular risks from other treatments such as immunotherapy or endocrine therapy, which is used commonly for breast cancer.

And so as we think about risk and who is at risk, you know, it varies on, on many different things. And a couple of things that we think about obviously are predisposing or underlying cardiovascular risk factors, you know, even before starting treatment. Blood pressure, cholesterol, diabetes, lifestyle, all of those things make a difference.

And then we think about, you know, in breast cancer, okay, what is the dose of some of these medications? Like anthracyclines, did the patient get left-sided radiation to the heart? Did they end up getting a treatment that had both anthracycline and anti HER2 therapy? Right? So we think about all of these things together and on this conversation, we're not going to be able to necessarily help everyone figure out if they are at risk or not, but there are three questions that I recommend that patients ask their medical team. One is, you know, did any part of my treatment increase my risk of cardiovascular disease? Is there any monitoring that I need to have due to my current or prior treatment?

And would I benefit from seeing a cardiologist or cardio-oncologist? And I think that if you take those three questions and bring them to your medical team, those are really good action points that will then hopefully start that conversation.

Host: Yeah. And Dr. Abbate, I'm wondering are there some signs or symptoms maybe that patients should be watching out for?

Kariann Abbate, MD: Yeah, good question. So we do act preemptively with many of these patients, and we get echocardiograms on a protocoled basis to ensure that their heart strength is remaining normal when they're receiving these therapies, or if we feel that there are risk factors that may cause their heart to weaken through the course of the therapy.

And we do these echocardiograms with some special measurements that will detect subtle changes in the heart so that we can kind of nip things in the bud and if we see any subtle changes that are indicating an impact from the therapy, we can initiate the heart strengthening medications. But in terms of signs and symptoms to watch out for, we counsel patients to keep an eye out for any shortness of breath, chest discomfort, dizziness, lightheadedness, difficulty sleeping at night because they feel short of breath, ankle swelling. All of those are signs that the heart may be impacted by their cancer therapy.

Host: Yeah. And Dr. Abbate, I want to stay with you, wondering how the two of you and your teams collaborate to ensure patients receive comprehensive care that protects both the heart and their cancer outcomes.

Kariann Abbate, MD: So, Dr. Teplinsky and her team and my team as well are in close communication. Whenevere there's a patient that Dr. Teplinsky's team feels is at high risk of having adverse outcomes from their cancer therapy; we will have a conversation, or we'll make sure we collaborate early on to get the patients the monitoring and the treatment that he or she needs during the course of their therapy. And then we have open communication, anytime there's ever a concern, either from my end or from Dr. Teplinsky's, and we make sure that we address it very quickly so that we don't interrupt the cancer therapy that the patient needs.

Host: Yeah. Dr. Teplinsky, it sounds like a lot of communication, collaboration between the respective teams.

Eleonora Teplinsky, MD: I agree, and we really try to think of it, you know, who's at risk before they even receive the medications. And referring to cardiology as appropriate, getting those echocardiograms, but then also in that survivorship phase after that active treatment has been completed. Thinking who is at long-term risk for cardiovascular disease and making sure that we are appropriately referring to the cardiology teams.

But you know, it's all about that communication, which really I think, serves the patient in the best possible way.

Host: Yeah. I love hearing about this team approach. I know it's so common now in medicine and, and great to hear in terms of cardio-oncology that you guys are working together, communicating, collaborating, and Dr. Teplinsky, for patients newly diagnosed with cancer, how do you help them prepare to maintain their overall health, including their heart throughout treatment?

Eleonora Teplinsky, MD: That's a great question. And it really starts by getting to know the patients. And so when we're meeting them and we're hearing about their cancer diagnosis, we're also learning about who they are, what is their medical history, what medications are they taking, what is their lifestyle? Are they exercising, smoking, alcohol history?

You know, all of this information, which helps us figure out what are they going to be at risk for with the treatment that they're going to be receiving? What side effects may they be expecting and then we can counsel them appropriately. We do a big push on movement throughout treatment.

And I'm not talking about, you know, going out and running a marathon or Olympic weightlifting, but you know, I tell people, let's get out, let's get out for walks several times a week. Maybe pick up some light weights if you feel up to it. But we know that movement and, and we've actually done this study at Valley.

We know that movement helps significantly. It attenuates some of the decreases in fatigue and strength that they experience with treatment and it helps their heart. So that's something that we really, really focus on. And from a cardiovascular perspective, again, you know, getting the appropriate imaging if they're going to be at risk for cardiovascular disease, and referring to cardiology as necessary.

Kariann Abbate, MD: And I'd just like to add that Dr. Teplinsky's team, and the whole oncology community does such a great job in managing these patients and the survival is so much better than it was years ago. And thankfully, you know, people are doing well from a cancer standpoint and we want to make sure that once they get through that treatment, that they do well from a cardiac perspective.

We don't want them to overcome a cancer diagnosis, but then down the road discover that they have heart disease. So want to make sure that we're managing all of their risk factors and making sure that they're successful, not just from an oncology standpoint, but also from a cardiovascular standpoint.

Host: Right. I see what you mean. You, you've survived cancer, but now you have heart disease and this is a whole other can of worms, if you will. And you must have read my mind, Dr. Abbate because I wanted to ask you, you know, how do you approach caring for patients who already have heart disease and are about to begin or are currently undergoing cancer treatment?

Kariann Abbate, MD: Yeah, that's a great question. So, we want to make sure that the cardiac problems are as optimized as possible. We want to make sure that any coronary disease has been addressed, that if they do have a prior diagnosis of heart failure, that they're optimized, that there's no significant valve issues that we need to deal with.

We want to make sure any comorbidities like diabetes, renal disease, arrhythmias, are all optimized as best as possible because that will allow the patients to be able to get the required cancer therapies with minimal interruptions and feel as good as possible during their treatment process.

Host: Yeah. Wondering what types of testing or monitoring you use to track a patient's heart health during and after cancer therapy?

Kariann Abbate, MD: So we use echocardiography and EKGs most commonly. And then depending on if there's any other problems that we're keeping an eye on; sometimes we do have to use other modalities, but I would say Echo and EKG are our two main ones.

Host: Yeah, it's really interesting. It's such a fascinating topic and as Dr. Teplinsky said earlier, we're probably not going to get to everything today, but maybe the headlines you enough to have folks speak with their providers, get the right referrals, all of that. And Dr. Teplinsky, what's one piece of advice you would give someone who's navigating both cancer treatment and, you know, concerns about their heart health?

Eleonora Teplinsky, MD: Yeah. You know, I think that's a really important question because I will tell you that sometimes patients are very nervous, appropriately so, about what is going to happen to their heart, knowing that heart disease is the leading cause of death in women and they are hesitant sometimes to undergo certain cancer treatments because of this, and I hope that this conversation provides some guidance and reassurance that we do have really excellent ways to take care of people's hearts, both during and after cancer therapy.

And so the goal is to be empowered and to be educated, but not to have alarm or panic that the cancer treatment is going to impact the heart, because the risks of that happening is still very, very low. And we have in the last decades, have become much better at predicting who is at risk and how to address that empirically before something develops.

Host: Yeah, it sounds like there's a lot of work done beforehand, as we discussed here today. Communication, collaboration, you know, assessing risk before treatment, all of that. Last word to you, Dr. Abbate. Great to have you both here, you know, what would be that one piece of advice you would give potential patients?

Kariann Abbate, MD: Well, prevention is always the best treatment and, and the best cure. So really try to, as Dr. Teplinsky said, stay moving, focus on a plant-based diet, try to manage stress the best we can. Doing those things will help prevent both heart disease and cancer. And then, you know, if we ever did have to deal with these diagnoses, we'll have the best chance of having a successful treatment plan and recovery because we're going into it in the best shape possible.

Host: Yeah, of course we can't outrun family history and genetics, but so many things are within our control, as you say, diet, exercise, lifestyle, all of that. So, thank you both for being here. Appreciate it.

Kariann Abbate, MD: Thank you.

Host: We hope today's discussion on cardio-oncology has shed some light on the vital connection between heart health and cancer care. Whether you or a loved one are going through treatment or simply want to stay informed, remember, collaborative care can make all the difference.

 For more information and resources, visit valleyhealth.com/heart. And as always, be sure to subscribe and share this episode, and take good care.