Cardio-oncology — a relatively newly introduced medical service that focuses on the cardiovascular health of cancer patients before, during and after cancer treatment — has been introduced on the African continent for the first time at Netcare uMhlanga Hospital near Durban.
“The development of this important medical service follows international recognition that cancer patients with co-morbidities and/or treatment-related cardiovascular problems can benefit greatly from a cardiovascular and oncology team approach,” says cardiologist, Dr YT (Trishun) Singh, who has been a driving force behind the establishment of the new cardio-oncology unit at the hospital.
Craig Murphy, regional director coastal: Netcare’s hospital division, congratulated Dr Singh and his team for introducing the new cardio-oncology service to South Africa. “There is a tremendous need for the cardiovascular health of cancer patients to be assessed prior to and during cancer treatment, as well as for longer term monitoring, to appropriately address any cardiovascular risks and minimise the impact on their health in the long term,” he affirms.
“Until now, a cardiologist has generally not been part of the multi-disciplinary oncology team. This newly-introduced cardio-oncology approach, and the development of this new unit, will assist in incorporating cardiac care in the treatment of cancer patients, as well as in preventing cancer patients whose cancer treatment has been successful from possibly having their health impacted by a cardiovascular event later,” adds Murphy.
“Dr Singh has trained extensively in cardio-oncology abroad, and the unit at the hospital has been equipped with a state-of-the-art cardiovascular ultrasound system, which is used in the early detection of cardiovascular problems.
“Dr Singh is also committed to sharing his knowledge with colleagues in South Africa and, as far as possible, assisting with introducing the cardio-oncology service at other facilities in the country.”
Dr Singh says in the oncology patient, the focus has traditionally, and quite understandably, been first and foremost on treating the cancer. “With earlier detection and more advanced treatments, oncology medicine is increasingly successful in treating paediatric and adult cancer patients, with cures now commonly being achieved by means of chemotherapy and radiotherapy,” he points out.
“A number of cancer patients, however, may have co-morbidities associated with cardiovascular disease, such as diabetes and hypertension, or cardiovascular co-morbidities such as ischaemic heart disease or heart valve problems that are not managed appropriately during cancer treatment,” he adds.
“As cardiovascular diseases can be exacerbated by certain oncology treatments, this can have important negative consequences for the long-term health of these cancer patients. In addition, cancer treatments such as chemotherapy, Herceptin [trastuzumab], targeted therapy and certain radiation therapies, can result in patients experiencing serious cardiovascular health problems over the longer term.
“In a significant number of patients these therapies can accelerate atherosclerosis, the build-up of fats and cholesterol, or plaque, on the walls of the arteries, and increase their risk of developing cardiac dysfunction, heart rhythm disorders, heart valve disease and other problems related to the heart and blood system [vasculature] over the longer term,” he explains.
The International Cardio-Oncology Society (ICOS) notes on its website that: “Therapies against cancer, even if increasingly effective and sophisticated, can cause high incidences of damage even to a healthy heart or they can worsen the cardiac function when it is already impaired.”
“As the numbers of survivors grow so does the number of patients living with the late effects of cancer-related cardiotoxicity. Amongst [Hodgkin’s] lymphoma patients who have received radiation, CVD [cardio-vascular disease] is one of the most common causes of death,” points out ICOS.
According to Dr Singh, the cardiologist team at Netcare uMhlanga Hospital has knowledge of the side effects of cancer therapies and works closely with the multi-disciplinary oncology team to assess the patient’s cardiovascular risks prior to treatment. This can assist in guiding the approaches taken to manage an individual’s cancer. The team then proactively works to address any cardiovascular risks before, during and after cancer treatment.
“Often the cardiovascular side effects of oncology treatment only become evident after a number of years. For example, a child successfully treated for cancer often presents with cardiovascular disorders some years later. If these patients had their cardiovascular health closely monitored so that these disorders were timeously detected, managed and treated, lives would undoubtedly be preserved. These are among the critical tasks of the cardio-oncology team.”
Earlier this year, Dr Singh attended a cardio-oncology conference in Washington in the United States. There he met with Professor Bonnie Ky, head of Cardio-Oncology at Pennsylvania University and co-organiser of the conference, as well as Professor Daniel Lenihan of Washington University, St Louis, who is president of ICOS.
“Both are committed to promoting this new service internationally and expressed their wholehearted support for the establishment of the first cardio-oncology unit in South Africa. They have provided invaluable guidance in this regard,” says Dr Singh.
Dr Singh has worked closely with Dr Ria David, a Durban-based medical oncologist, and Dr Ines Buccimazza, a surgeon and head of the Breast Unit at Inkosi Albert Luthuli Hospital/Nelson Mandela School of Medicine, to establish the first cardio-oncology unit in South Africa at Netcare uMhlanga Hospital, and both are on the executive committee of the new unit with Dr Singh.
The first cardio-oncology society in South Africa, and in fact on the African continent, has been formed and registered as a non-profit organisation called the Cardio-oncology Society of Southern Africa (COSOSA), with the executive comprising Dr Singh, Dr Buccimazza and Dr David. The first all-day inaugural meeting will take place at the Gateway Conference Centre in Durban, on Saturday, 7 March 2020. Professor Daniel Lenihan of Washington University and Professor Eric Harrison of Tampa, Florida will be keynote speakers.
Key to the accurate assessment of cancer patients for cardiovascular conditions at the cardio-oncology unit is the use of technology such as the recently introduced GE Vivid E95 4D cardiovascular ultrasound technology. Dr Singh says that the equipment’s enhanced 2D and colour image quality enables heart function to be easily quantified and any cardiovascular problems to be quickly and clearly visualised. This high-end GE ultrasound technology is able to detect early possible damage to the cardiac muscle due to cancer therapy.
“It is most affirming that we have been able to establish this new cardio-oncology unit at Netcare uMhlanga Hospital for our patients in the KwaZulu-Natal region. Dr Singh and his team are to be congratulated for addressing this important need and for assisting to bring South Africa in line with international trends in cardio-oncology treatment,” concludes Sara Nayager, general manager of Netcare uMhlanga Hospital.
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