Dr Tochi Okwuosa: Baseline Risk Assessment of Heart Function Necessary in Cancer Care

Tochi M. Okwuosa, DO, cardiologist and director of cardio-oncology at Rush University Medical Center in Chicago, addresses the concerns that should be top of mind regarding cardiovascular and heart health for patients receiving treatment for cancer.

Baseline risk assessment that includes prior treatment history for cancer, prior cardiovascular events, and markers for potential heart damage are all important, she emphasizes.

Transcript

Prior to cancer treatment, what measures should patients and their care teams take to ensure short- and long-term heart health?

One thing is baseline risk assessment. That should include a proper history. You want to understand, has the patient had prior cancer treatment? If they did, had they had prior cardiovascular events as a result? If they did, where are they now with all of those cardiovascular events? What sort of treatment are they going to be going through, and how long? What's the duration of the treatment? What's their cancer prognosis? All of these. And, what's their cancer stage? All of these things are the sorts of things that are going to influence the decisions that you make in managing the patient. And then, of course, you want to know things like their family history—are they smokers?—and a whole bunch of other things.

Then you also want to get, depending on the kind of cancer treatment they're going to be receiving, you also want to get cardiovascular markers, right. So, the labs, the BNPs [B-type natriuretic peptides] and troponins that at baseline can influence how you manage these patients now and moving forward as they’re receiving treatment. You also want to get an echo [echocardiogram]. Most of the patients who are referred to a cardio-oncology clinic have to get an echo at baseline, because you want to know what their heart function is. How well is their heart squeezing or not. And then strain. Strain echo is a sort of software that comes with the echo machine that gives us a lot of information at baseline, and then gives us information that we can use to determine whether to start them on certain types of cardiac treatments or not to be able to manage them as they're receiving cancer treatment.

So there are a lot of things that you have to kind of think about at baseline. What’s their baseline cholesterol level? What’s their baseline A_1C [glycated hemoglobin]? What’s their baseline blood pressure? What’s their baseline heart rate? All of those things are things that have to be plugged into the equation in terms of thinking about the patient's risk factors at baseline and then thinking about how to manage them moving forward.