Physicians at Vanderbilt University Medical Center, Nashville, have opened a dedicated cardio-oncology service, including urology, medical oncology, radiation oncology, and cardiology.
Multispecialty collaboration is key to managing cardiovascular risk in cancer patients who have undergone therapies such as androgen deprivation therapy (ADT).
“ADT definitely puts prostate cancer patients at risk for heart disease, in addition to other conditions, including diabetes. Other treatments, including some of the chemotherapeutic agents used in late [stage] disease, may not be good for the heart, either. [But,] ADT is definitely the worst offender,” said study author David F. Penson, MD, MPH, of Vanderbilt University Medical Center, Nashville.
To address the increased risk among cancer survivors, Dr. Penson and colleagues at Vanderbilt have opened a dedicated cardio-oncology service, including urology, medical oncology, radiation oncology, and cardiology.
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“This service facilitates interaction between the patient, his urologist, his medical oncologist, and his cardiologist to help us manage his heart disease risk as a team,” Dr. Penson said. “Patients undergo cardiovascular workup as appropriate and, importantly, are counseled about dietary and exercise changes they can make to reduce their risk of heart disease.”
ADT use appears to be linked with increased low-density lipoprotein and triglyceride levels, increased fat and decreased lean body mass, increased insulin resistance and decreased glucose tolerance, and a condition similar to metabolic syndrome, according to a study published by the Vanderbilt researchers in Circulation (2016; 133:537-41).
“Aggressive treatment of these altered cardiovascular risk factors can be an important step to decrease the risk of heart attack and stroke in patients treated with ADT,” said senior author Javid Moslehi, MD, of Vanderbilt University Medical Center, in a Vanderbilt press release.
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Dr. Moslehi helped develop the Vanderbilt ABCDE algorithm to reduce cardiovascular disease risk among cancer survivors. The ABCDE algorithm includes awareness and aspirin, blood pressure monitoring, cholesterol management and cigarette avoidance, diet and diabetes, and exercise. The National Comprehensive Cancer Network is adapting the algorithm into its national cancer survivorship guidelines, according to the release.
Prostate cancer patients undergoing ADT and other cancer treatments need to know about the cardiovascular toll, and urologists can take the lead in not only educating patients but also collaborating with other specialties, according to Dr. Penson.
Dr. Penson said urologists treating prostate cancer patients should seek input from their colleagues in cardiology, as well as think twice before recommending ADT.
“Urologists still prescribe a lot of ADT. We can help our patients by making them aware of their heart disease risk on ADT and making interventions to decrease this risk,” Dr. Penson said. “Importantly, this is another reason that urologists need to be thoughtful about which patients they put on ADT. There are clearly times when ADT is absolutely indicated, but there are other situations where its use is more ‘discretionary.’ Urologists may wish to avoid this discretionary use in patients who are already at risk for heart disease.”
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