Dr Tochi Okwuosa: Multidisciplinary Collaboration Vital for Preventing Cardiac Damage From Cancer Care

Tochi M. Okwuosa, DO, cardiologist and director of cardio-oncology at Rush University Medical, discusses the multidisciplinary process that underlies caring for patients with cancer who may develop damage to the heart, and the vital contributions from other medical specialties—chief among them general internal medicine, pulmonology, and psychology.

Transcript

Can you explain the importance of multidisciplinary cardiac damage prevention within oncology care?

Cardio-oncology, in a nutshell, is the study of heart disease in cancer patients. Heart disease in cancer is how we usually think about it. Usually this is heart disease that’s mostly a result of treatment. Some people can put cancer of the heart in that umbrella, but it's really basically the treatments for cancer and the way they affect the heart.

The typical person that practices cardio-oncology, the cardio-oncology specialist, has to understand all these different cancer treatments and how they affect the heart. It’s a very broad field, because it's not just cardiology. It’s also oncology and, really, knowledge of general internal medicine in order to be able to practice cardio-oncology. Because if you think about it, the cancer patient has multiple different issues, right? Whether it's GI [gastrointestinal] or the heart, or the brain, or the kidneys, or the lungs, a whole bunch of other organ systems that are affected. You can imagine that you have to kind of think broadly. It's a multidisciplinary process.

I am heavily reliant on the oncologists to tell me what's going on with the patient because they're the ones giving these treatments to patients. So, what is the patient's prognosis? What sorts of other issues are you concerned about with this treatment that you're giving to the patient? What's the next treatment? What are the other accompanying treatments that you're gonna give with this particular one? I'm heavily reliant on them to give me some information.

Then also, we have the other subspecialties in medicine. Lungs, right? The pulmonologist is relevant; the nephrologist, or the kidney doctor, is relevant; the GI doctor. All of these people are relevant because they give me some sense of how to think from a cardiovascular standpoint while they're managing that other organ, whatever organ it happens to be.

Then, most importantly, the patient’s psychological health is extremely important, because in the end there's a lot of anxiety associated with the cancer diagnosis and then cancer treatment. Patients get depressed, too, especially if they don't have great social support and so on. So there's a lot that goes on. I'm heavily reliant on our social workers and our case managers, in terms of taking care of these patients. This is really true.

And then diet, the sorts of foods they should eat. Cancer patients are losing weight. At the same time, we're concerned that if they're eating a lot of sugars, a high-fat diet and all that, that also could feed the cancer. So really heavily reliant on the dietician that's going to be advising these patients on the sorts of foods they should be eating. And then there's the endocrinologist. Thyroid issues affect the heart, affect cancer and cancer treatments, and so on. It really is a multidisciplinary push.

Rehab, too. A lot of our patients, you want physical activity; you want them to be moving and not just to be sedentary while they're receiving treatment because these patients, when they get sick—because they're getting tons of treatment—functional capacity falls and then it's kind of difficult to recover that functional capacity. So how to engage these patients in physical activity while they're getting treatment and, most importantly, after treatment is done to kind of get them moving and not just remain sedentary because they're tired and they're not feeling so well, which is very much understandable.

So, it's absolutely multidisciplinary in every way that you can think about. Exercise physiologists all know me because I'm always asking their opinion and sending patients to them to get patients moving. So yes, it's definitely multidisciplinary in every way.

And then let's not forget our researchers, because they also bring up interesting questions. I have a lot of collaboration with those people. I do some research myself, but the PhDs and the people that actually focus on research, there's a lot of collaboration back and forth between cardio-onc and researchers, because we’ve got to understand a whole lot more—clinical trials and the rest of them when it comes to cardio-onc. So definitely multidisciplinary, more so than any other field in medicine.

There's also the multidisciplinary aspect that has to do with cardiology itself, right? For example, I'm a general cardiologist practicing cardio-onc, but I'm reliant on the interventional cardiologist and electrophysiologist and the rehab cardiologists, and so on—all of these other people that I sometimes send my patients to because they need specialized care from their particular field. These are all people that are very important and these are all people that help make the field as robust as it is. So yes, collaboration is extremely important.