Why you should know more on Cardio-Oncology

Dr Trishun Singh, cardiologist and chairperson of the newly-established Cardio-Oncology Society of Southern Africa. Picture: Supplied

Dr Trishun Singh, cardiologist and chairperson of the newly-established Cardio-Oncology Society of Southern Africa. Picture: Supplied

Published Mar 14, 2020

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Specialist doctor, Dr Trishun Singh, explains why Cardio-Oncology should be on your radar. A cardio-oncologist is a cardiologist, who has a special understanding of cancer therapy and the effects on the cardiovascular system.

The cardiologist involved with cardio-oncology has to also recognise the risk factors that make the management of the cancer patients worse:

 

Thus, patients with diabetes, hypertension, obesity and cholesterol problems need to be identified and treated appropriately before they start cancer treatment.

When cancer patients start treatment, these risk factors need to be dealt with, together with the cancer treatment, to give the patient an optimal result from treatment.

You cannot treat the cancer and allow the patient to die from a cardiovascular event. The common dictum now is do not let the cancer patient of today die from a cardiovascular event tomorrow.

Cardio-oncology is a necessary and rapidly-growing field of medicine:

The cardio-oncologist has to work closely with the oncologist in identifying risk factors that can make the cancer management worse. Almost all cancer patients have cardiovascular risk factors.

If you look for the risk factors, you will find them. The problem is massive. Cancer survivors are increasing in numbers, worldwide. If we do not address these issues, the cancer survivors will end up having a massive problem with regard to cardio-oncology management. This will lead to a huge burden on our already overburdened health-care system.

Many of the underlying risk factors that cause cancer also cause cardiovascular problems, for example, obesity, smoking, diabetes, hypertension and cholesterol:

There is an inflammatory element causing blockages in the arteries, but there is also an inflammatory process involved in cancer.

Radiation, particularly to the chest, affects the heart muscle, the heart valves and the surrounding tissue of the heart called the pericardium  and the autonomic nervous system.

What is particularly worrying is that many of the childhood cancers, namely the lymphomas, like Hodgkin’s lymphoma and non-Hodgkin’s lymphoma, have a high level of cure. These children, in great numbers, are cured of their cancer but they present with cardiac failure and ischaemic heart disease 10 years earlier than their adult counterparts, who have never had cancer.

For instance, if an adult who has never had cancer presents with a heart attack, angina or cardiac failure at the age of 40, then it has been shown that a childhood cancer survivor will present with the same problem at the age of 30.

To avoid this, The childhood cancer survivors will need to be carefully followed-up at the end of their cancer treatment in childhood, at least every two to five years, for the rest of their lives. This, unfortunately, is not adequately dealt with in South Africa.  

Do not let the cancer patient of today die from a cardiovascular event tomorrow.

*Singh is the Chairperson of the Cardio-Oncology Society of Southern Africa (Cososa) - the first cardio-oncology Society in Africa. Cosasa’s first inaugural meeting was held at the Pearls of uMhlanga on March 7. 

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