New service tackles cancer patients with heart problems

16 Mar 2009

The European Institute of Oncology (IEO) has become the first comprehensive cancer centre in Europe to offer patients a ‘Cardioncology’ service, specifically treating cancer patients who have associated heart problems - an ever increasing category.

"By reducing mortality and increasing the effectiveness of care, the number of individuals living with cancer is increasing, and they are also living much longer", says Dr Carlo Cipolla, Director of the Division of Cardioncology at IEO. "Hence, the number of cancer patients who already have heart problems or who will develop them during their cancer treatment is also increasing. Such patients undergoing either chemotherapy alone or in combination with other types of treatment should be protected from the possible effects on the cardiovascular system (cardiotoxicity).

“This has created the need for a physician with dual expertise in oncology and cardiology and has resulted in the birth of a new medical speciality: Cardioncology” says Cipolla.

"The cancer patient with cardiovascular problems is often met with caution by the traditional cardiologist who is often unable to treat the cardiotoxicity. Even the most experienced cardiologist requires years of specific experience in the field of oncology to know how to prevent cardiotoxicity arising from chemotherapy, to better prepare the cancer patient for anticancer therapies, both medical and surgical or to diagnose and treat neoplastic pericardial effusion – the collection of fluid around the heart which can be a source of metastatic tumour cells and a cause of cardiac dysfunction."

A further problem is that the patient, divided between the oncologist and the cardiologist is not treated in an integrated manner, and either the cancer care takes precedence over the cardiological or vice versa, with potentially dangerous consequences.

The new cardioncology service at the IEO works closely with the Coronary unit of the 'Centro Cardiologico Monzino – Milan' to prevent, diagnose early and to treat potential cardiac problems which may co-exist with the oncological condition. The staff of the unit are also available to give advice to oncologists and cardiologists from other hospitals; prior to surgery to help assess the real operative risk, to optimize the pre-treatment and to advise on creating stable cardio-pulmonary conditions so that as many patients as possible can be operated safely.

They can interact with the oncologist to recognize at an early, preclinical, asymptomatic stage, potential cardiotoxicity resulting from chemotherapy (a side effect of many drugs and underestimated in approximately 20% of cases). They can help the oncologist to choose drug therapies with the least possibility of causing cardiotoxicity and in the case of already existing cardiotoxicity, to prevent further toxicity or, if possible, to lessen the existing cardiotoxicity

Thanks to their intensive work in this field and to the numerous scientific publications on the topic of cardioncology, the cardiologists from IEO are considered international leaders of this new discipline. As a result, on the 29th January 2009, the International Cardioncology Society (ICOS) was founded at IEO and, in collaboration with the MD Anderson Cancer Center in Houston, the first International Conference of Cardioncology will take place in IEO on the 25th - 26th September 2009.