MDNews - Greater Kansas

Associate Professor of Medicine and Cardiology and Director of the Cardio-Oncology Program at Rush University Medical Center in Chicago, tells MD News. "But there is a need for it. Now, as cancer patients are living longer, there is a an even greater need." In 2015, Dr. Okwuosa co-authored a paper with Dr. Barac and Edward T.H. Yeh, MD, exploring the development of cardio-oncology. The paper, also pub- lished in the Journal of the American College of Cardiology, details the importance of collaboration among a multidisciplinary team of clinicians, including those specializing in car- diovascular disease, heart failure, oncology and psychosocial support, as well as primary care providers. It calls for institutional support for cardio-oncology training as well. Four years after the publication of that paper, Dr. Okwuosa is encour- aged by progress toward achieving that goal. However, she notes, much work remains. "Ideally, I would like to see train- ing become Accreditation Council for Graduate Medical Education- accredited," Dr. Ok w uosa says. "I rea lly would like to see some specialized training for the field of cardio-oncology and for the American College of Cardiology, in conjunction with the ACGME, to generate a set of parameters for training ... and standardize those parameters across institutions." OVERCOMING BARRIERS Establishing the right training and attracting clinicians to the field is critically important to the health and longevity of patients living with comorbid cancer and cardiovascular disease as well as to cancer survivors, Dr. Okwuosa says. But there are hurdles to overcome in terms of the existing perceptions of specialists. "The cancers that used to kill within six months or a year," Dr. Okw uosa says, "people a re now getting four, f ive, si x years with those cancers because of immunotherapies and advanced therapy." However, the field of cardiology has not always responded promptly to advances in survival, meaning patients in some cases do not receive the care they need "to live at maximum capacity from a cardiovascular standpoint," she adds. Updating cardiology training is crucial, says Bonnie Ky, MD, MSCE, Associate Professor of Medicine and Epidemiology at the Perelman School of Medicine at the University of Pennsylvania and co-senior author of the more recent Journal of the American College of Cardiology paper. "Inclusion of cardio-oncolog y as a component of general cardiology training programs is the first step in establishing a workforce capable of recognizing and managing the complex cardiovascular burdens associated with cancer in every com- munity," Dr. Ky states in the news release. THE VALUE OF SPECIALIZED CARE When patients do receive collaborative cardio-oncology care, the results can be transformative. One patient Dr. Okwuosa treated was living with non-Hodgkin's lymphoma. However, because the active 82-year-old also had severe aortic valve stenosis, the cardiotoxic chemotherapy that could cure his non-Hodgkin's lymphoma was deemed high-risk. "They consulted us in cardio-oncology because they were really concerned," Dr. Okwuosa says. "We arranged for the patient to have transcatheter aortic valve replacement to get that aortic valve fixed in a very expeditious manner." That, in combination with the use of an agent, dexrazoxane, that helps prevent cardiotoxicity, enabled him to receive the treatment he needed. "He went back to exercising after treatment was completed and did well," Dr. Okwuosa says. "This is a good outcome because the oncologist consulted us, and we worked together to get [the patient] where he needed to be with minimal toxicity. He is now five years out from his cancer therapy." n " We are realizing more and more cardiotoxic profiles of a lot of these [cancer] treatments. ... Involving a physician who is well- versed in cardio-oncology — even if it is a general cardiologist who is knowledgeable about cardio-oncology — is important." — TOCHI M. OKWUOSA, DO, FACC, FAHA, ASSOCIATE PROFESSOR OF MEDICINE AND CARDIOLOGY AND DIRECTOR OF THE CARDIO-ONCOLOGY PROGRAM AT RUSH UNIVERSITY MEDICAL CENTER M D N E W S . C O M /// M D N E W S G R E AT E R K A N S A S ■ 2 019 1 3

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