St. Mary's Health Care System and Oconee Heart and Vascular Center are creating the area's first program to provide early detection of heart problems in patients undergoing treatment for cancer.

St. Mary's Cardio-Oncology Program uses innovations in cardiac MRI and echocardiography to uncover heart damage in its earliest stages, when the patient and his or her oncologist may still have options to fight the cancer while protecting the patient's heart.

"Until now, oncologists had no way of knowing if cancer treatment was harming the patient's heart until it was too late to do anything about it," said cardiologist Erick Avelar, M.D., clinical director of St. Mary's Cardio-Oncology Program. "Now, we can provide information that can help oncologists and their patients make better-informed clinical decisions.

"The basic issue is that the medications used to fight cancer can be toxic to the heart," Dr. Avelar explained. "Patients are living longer after being diagnosed with cancer, especially breast cancer. But now, more cancer patients are dying from cardiovascular disease than cancer."

The most common and most dangerous of these cardiovascular diseases is heart failure. In heart failure, the heart becomes too weak to pump blood effectively, leading to fluid build-up inside the body that stresses the heart and many other vital organs. This stress can lead to progressively worsening symptoms such as swelling of the feet and ankles, fatigue, shortness of breath, kidney failure, coma, and ultimately, death.

Chemotherapy and radiation therapy also can lead to coronary artery blockages, arrhythmia, or swelling of the tissues around the heart. Problems are most common in patients with high risk factors for heart problems, including smoking, obesity, sedentary lifestyle, a high-fat diet, and family history of cardiovascular disease.

St. Mary's cardio-oncology program makes use of upgraded MRI and echocardiography systems that are sensitive enough to detect very subtle damage to heart tissue. Armed with this information, oncologists can work with their patients to minimize heart damage while fighting the underlying cancer.

"With older technologies, we didn't have the tools oncologists needed to assess the impact of cancer treatment on the heart," Dr. Avelar said. "Heart damage could not be detected until ejection fraction – the amount of blood pumped by each contraction – began to decrease. By that time, the heart has already suffered a great deal of damage. With these new technologies, we can detect signs of potential damage earlier, often before the whole heart has been irreversibly weakened."

Another key component of the program is registered nurse navigator Caitlin Strickland, who comes to St. Mary's from the outpatient oncology infusion program at Northside Hospital of Atlanta. At St. Mary's, Strickland provides patients with education about imaging studies and lab tests, assesses patients for new and ongoing cardiac symptoms, monitors test results, and coordinates communications with the cardiologist.

"As a nurse with a strong background in oncology, I am thrilled to have the opportunity to be part of a program that will improve the quality of life and long-term survival rates of cancer survivors," Strickland said. "Two of my greatest passions in medicine are patient education and disease prevention. I look forward to guiding patients through the cardio-oncology process to help minimize their risk of developing chemotherapy-induced cardiac disease."

Patients normally will enter St. Mary's Cardio-Oncology Program during chemotherapy and may continue for months or even years afterwards. Patients and survivors undergo testing on a regular basis, usually every three months. Testing includes a clinical examination, non-invasive MRI, echocardiography testing, and/or blood tests. If the cardiologist sees warning signs of trouble, the patient may be asked to come in for more frequent testing. Throughout the process, the cardiologist stays in close contact with the patient's oncologist, who can use the information to tailor cancer treatment to the patient's individual needs and wishes.