Credit: Jonathan Kozowyk
When I was in medical school, my maternal grandfather was diagnosed with cancer. As a consequence of his intense chemotherapy regimen, he wound up dying from heart failure. I always knew I wanted to be a doctor, but that experience drew me toward the intersection of heart disease and cancer, the two leading causes of death in the United States.
Some 40 percent of Americans will be diagnosed with cancer at some point during their lifetimes. Advances in early detection and novel treatment modalities have led to overall improvements in outcomes. Unfortunately, with longer survival comes an increase in long-term cardiac toxicity associated with chemotherapy, immunotherapy, targeted therapies, and radiation therapy. The vast majority of these treatments have the potential, either directly or indirectly, to contribute to cardiovascular conditions, including heart failure, high blood pressure, heart attack, valve disease, arrhythmia, and pericardial effusion, a buildup of fluid around the heart that can prevent it from pumping adequate blood to meet the body’s needs.
As one of the pioneers of the emerging field of cardio-oncology, I’ve spent more than a decade managing the health of thousands of patients on Long Island who have developed or are at risk of developing cardiac complications from cancer treatments. In December 2023, I joined ºÙºÙÊÓƵ Health with dual academic appointments at NYU Grossman Long Island School of Medicine and NYU Grossman School of Medicine. I serve as the system director for ºÙºÙÊÓƵ’s Cardio-Oncology Program, which unites oncologists, immunologists, and researchers from the Laura and Isaac Perlmutter Cancer Center with cardiologists and cardiac surgeons across the institution to coordinate personalized care for patients. Ultimately, we hope to expand the model to all of our campuses.
Cardiac toxicity is much more common than most oncologists and cardiologists realize, and it could warrant adjustments or even discontinuation of the cancer therapy regimen, adversely affecting outcomes. Cancer therapies have evolved so rapidly and so expansively in recent years that for many therapeutic agents, we simply don’t have longitudinal data on cardiac safety to guide us.
Since there’s no formula I can plug in, I look at a patient’s individual risk profile. Someone who has cancer, along with uncontrolled high cholesterol, elevated blood pressure, or diabetes, has a greater risk of developing a cardiovascular condition that could lead to a heart attack, heart failure, or stroke. The art of being a cardio-oncologist is trying to figure out how cancer and its treatment impact cardiovascular risk and finding the optimal balance.
If a patient has cardiac risk factors and the prescribed therapy is high risk, I will explore alternative therapies with the oncologist that might be less toxic to the heart but without compromising the patient’s outcome. When the patient is at high risk for a cardiac complication, the balance always comes down to the risk versus benefit of any given cancer therapy. I monitor the patient with ongoing blood tests and imaging, treating cardiovascular problems that may arise. The aim is to help patients receive and complete optimal treatment while protecting their heart, and to provide ongoing preventive care or treatment or both once their therapy is completed, well into survivorship.
My mission is to ensure that a patient understands and is comfortable with the short- and long-term risks of their cancer therapy. I take care of people for years beyond their treatment. I cherish these relationships, and I treat patients like members of my own family.
