What is cardio-oncology?

Cardio-oncologists work with hematology-oncologists and other oncologic health care providers to prevent and treat cardiovascular disease alongside cancer therapy and care.

Care by the cardio-oncologist can be provided prior to or during cancer therapy, in addition to preventive care and management of cardiovascular disease related to cancer therapy in cancer survivorship years.

Education and research

Cardio-oncology faculty and trainees at RUSH University participate in the following education and research efforts.

Education

  • RUSH Academy of Cardio-oncology, an online continuing medical education program geared toward clinicians, which covers one cardio-oncology case per month, with diagnostic and management decisions, citing articles for support and prepared by RUSH residents andfellows and overseen by program director Tochi Okwuosa, DO
  • Presentations at tumor board conferences, cardiology grand rounds, oncology grand rounds, internal medicine grand rounds — both at RUSH University Medical Center and throughout Illinois and Indiana
  • Fellows and residents rotating through clinic
  • Beginning in 2019, a biannual cardio-oncology patient education series geared toward specific cardio-oncology survivorship issues for discussion
  • Upcoming educational cardio-oncology newsletter

Research

Our bench-to-bedside approach is based on the close collaboration between basic science, led by Kathrin Banach, PhD, and clinical faculty, led by Tochi Okwuosa, DO. There are many opportunities in these efforts for residents, fellows and medical students, including the following:

  • Various projects on use of speckle tracking echocardiography in the prediction of cardiovascular disease in the setting of cancers and cancer therapies
  • Various projects on use of cardiovascular biomarkers (including BNP, troponin, CRP, as well as the novel marker suPAR) in the prediction of  cardiovascular disease in the setting of cancers and cancer therapies
  • Understanding the use of coronary calcium for CAD risk screening in cancer patients
  • Understanding the safety of use and cardioprotective effects of typical cardiovascular drugs (such as ace-inhibitors/ARBs, beta blockers, statins, aspirin, direct oral anticoagulants [DOACs]) in various cancers and cancer therapies

The survival rate of cancer patients has significantly improved over the past decades; however, many of the established as well as newly developed chemotherapeutic drugs and signaling inhibitors exhibit significant cardiotoxicity.

The cardiotoxic effects can lead to acute changes due to inflammation and changes in cardiac excitation (e.g., QT prolongation, dysrhythmias, coronary syndromes) or to chronic changes leading to ventricular systolic and diastolic dysfunction and congestive cardiomyopathy.

One example is the anti-tumor agent anthracycline (with doxorubicin (Dox) being one of their best known representatives), which finds broad application in breast cancer, the treatment of sarcomas, lymphomas and leukemia.

While effective, anthracyclines exhibit significant cardiotoxicity with early acute as well as chronically developing cardiac damage. Anthracycline-induced cardiotoxicity correlates with the cumulative dose of anthracyclines (max. 400 mg/m2) with a higher vulnerability in children <4 years, females, and patients with African American ancestry or down syndrome.

The increased vulnerability of children is of utmost concern given that the treatment of childhood leukemia, can result in severe cardiac disease in 25% of the cases within 30 years of survival.

Therefore our bench to bedside approach aims to i. to understand the cellular mechanism that lead to chemo-induced cardiotoxicity and ii. to develop pharmacological approaches to antagonize them; based on research we aim iii. to identify quantifiable parameters that allow the identification of patients at risk for chemo-induced cardiotoxicity, as well as iv. the development of new strategies for the early detection of chemo-induced cardio-toxicity.

In the laboratory, we have established an animal model of chemotherapy induced cardiomyopathy. The model allows us to do the following:

  • Monitor in vivo changes in the electrophysiological and contractile properties (EKG, ECHO) before, during, and after chemotherapy
  • Quantify structural changes, such as increasing cell death and tissue fibrosis, that can impact electrophysiological and contractile properties
  • Determine on a cellular level the signaling pathways that get activated or are impaired by chemotherapy

Using animal models with modified protein expression pattern, we can further simulate how certain predispositions (e.g., expression of certain bio-markers) contribute to the cardiotoxic impact of the chemotherapy applied.

We hope that our bench-to-bedside approach will lead to progress in the identification of patients at risk, earlier detection of cardiac remodeling and the development of new pharmacological strategies to prevent chemo-induced cardio-toxicity.

Symposium

Rush holds a cardio-oncology symposium biennially, with the next event happening Oct. 2, 2021. Nationally and regionally recognized faculty attend from all over the country.

  • Geared toward health care personnel involved in the care of the cancer patient and survivor, including primary care physicians, oncologists, cardiologists, nurses, nurse practitioners, physician’s assistants, pharmacists and interested medical students
  • Aims to create awareness of cardiovascular disease and concerns, as well as prevention and management in cancer patients and survivors

Clinical services

The Cardio-Oncology Program at RUSH is at the forefront of integrative medicine, understanding that multiple organ systems are involved when patients have cancer and receive treatments for it.

The Cardio-Oncology Program works closely with oncologists, advanced practice providers, nurses and other health care providers to ensure the best cardiac care for the oncology patient before, during and after cancer therapy.