Oregon Health & Science University
  • Maros Ferencik, M.D., Ph.D.Maros Ferencik, M.D., Ph.D.
    Dr. Ferencik cares for a wide range of heart problems in the general cardiology clinic at the OHSU Knight Cardiovascular Institute. He has a special interest in cardio-oncology, treating patients with heart conditions related to cancer and cancer treatment. Dr. Ferencik has advanced training in cardiac imaging, including echocardiography, computed tomography and nuclear cardiology.

New specialty lowers and possibly prevents heart risks from cancer treatment

Protecting cancer patients' and survivors' hearts

In the past generation, cancer therapies have improved survival rates dramatically. By 2022, the United States will have 20 million cancer survivors. However, some chemotherapy and other cancer treatments are known to be cardiotoxic, and the leading morbidity for cancer survivors is cardiovascular disease.

The role of the cardio-oncologist

This increased risk of heart disease led to the development of cardio-oncology, a cardiology subspecialty now on the scene for approximately 10 years. Cardio-oncologists care for two main patient groups: first, those with existing cardiovascular disease who are planning or undergoing cancer treatment. Patients with cardiovascular disease tend to have worse outcomes from cancer treatment; thus, appropriate therapy has the potential to improve not only the cardiovascular condition but also the oncologic outcome. The second group is patients who are planning, undergoing or have previously had potentially cardiotoxic cancer therapy.

At OHSU Knight Cardiovascular Institute, the dedicated cardio-oncology care clinic is staffed by three fellowship-trained cardiologists and a board-certified nurse practitioner.

OPTIMIZE CANCER TREATMENT, PROTECT THE HEART - OR PREVENT FURTHER DAMAGE

A cardio-oncologist's goal is to optimize the patient's cardiovascular performance before, during and after cancer treatment to allow for the most effective oncology care and maximize general health. Cardio-oncology care also aims to prevent the development or progression of heart disease, including through primary prevention of cardiovascular risk.

Before, during and after cancer treatment

PRETREATMENT CARDIO-ONCOLOGY CONSULTATION AND ASSESSMENT

Potentially cardiotoxic therapies such as chemotherapy with anthracycline, doxorubicin and post-breast cancer treatment trastuzumab as well as chest radiation warrant pretreatment consultation. Vascular endothelial growth factor inhibitors are also associated with cardiotoxicity.

CARDIAC CONCERNS DURING CANCER TREATMENT

Patients may develop signs or symptoms of cardiovascular disease during chemotherapy. These include heart failure, ischemic heart disease or coronary artery disease, arrhythmias or QT prolongation, valvular heart problems, arterial hypertension, pericardial effusion or clotting.

At OHSU Knight Cancer Institute, patients treated with anthracycline, trastuzumab, alkalyting agents, tyrosine kinase inhibitors and other targeted therapies receive regular echocardiographic screening. Results may prompt a referral for cardio-oncology management. The team also evaluates patients with subclinical decreases in heart function.

SURVIVORSHIP CARE AND RISK PREVENTION

The cardio-oncology team offers preventive consults for patients who have had any cardiotoxic cancer therapy, including baseline heart function assessment for treatment damage and atherosclerotic cardiac risk assessment based on epidemiological data. Lipid level control with diet, exercise, and if necessary, medication, is included. Additional risk assessment may include:

  • CT calcium scoring
  • 12-lead electrocardiogram, with heart monitor if appropriate
  • Echography to measure LV function
  • Myocardial strain imaging by echocardiography

Patients with prior mild damage may be prescribed beta blockers or ACE inhibitors to lower the risk of clinically significant disease. Patients also receive education on lifestyle and heart health.

TECHNOLOGY TAILORED FOR EACH PATIENT

Serum biomarkers cardiac troponin T and NT-proBNP are first-line measures for subclinical cardiac damage. OHSU's dedicated cardio-oncology protocol also includes evaluation of left and right ventricular function and myocardial strain imaging.

COORDINATED, MULTIDISCIPLINARY CARE GIVES SURVIVORS MORE OPTIONS

Some cancer survivors may forego definitive cardiac interventions because of concerns about undergoing a heart procedure. The OHSU cardio-oncology team connects patients and providers with the OHSU Knight Cardiovascular Institute's Complex Heart Valve team, which offers internationally recognized expertise in minimally invasive treatments including transcatheter aortic valve replacement and catheter-based mitral valve repairs.

Clinical trials on heart disease and blood cancer

Cancer and heart disease tend to develop in the sixth and seventh decades of life. Cardio-oncology program director Maros Ferencik, M.D., Ph.D., and OHSU Knight Cancer Institute researcher Kim-Hien Dao, D.O., Ph.D., are conducting the Women Engaged in Advancing Health Research, or WEAR, study. This first-of-its-kind trial aims to define blood cancer risk in women with certain genetic variants and develop new early detection and prevention strategies for blood cancer and heart disease. Investigators are currently enrolling healthy volunteers. Visit www.wearinoregon.org to learn more.

When to refer

Patients who benefit from cardio-oncology referral include:

  • Any cancer survivor who develops heart failure, arrhythmia, angina or concerns for cardiac effusion.
  • Any survivor with a history of heart disease or who has undergone cardiotoxic cancer treatment.
  • “Worried well” survivors — For example, breast cancer or lymphoma survivors interested in their longterm heart disease risk.
  • Patients with newly diagnosed malignancies whose treatment plans include anthracycline, doxorubicin, trastuzumab, some kinase inhibitors, chest radiation or other cardiotoxic therapies.

Patients have easy access to cardio-oncology services through the OHSU Knight Cancer Institute clinic in Beaverton. Outpatient consultation is also available at the Center for Health & Healing in Portland's South Waterfront district and at the OHSU Center for Women's Health.

Contact us

The cardio-oncology team at the OHSU Knight Cardiovascular Institute is always available to answer questions and to assess and manage patients' heart risk while maximizing the outcomes of cancer therapy. For a consultation, please call the OHSU Physician Consult & Referral Service at 503-494-4567. To refer a patient, please fax to 503-346-6854.

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