Leading-edge treatments that help patients beat cancer come with a catch — an increased risk for heart disease.
"For many of the most common cancers like breast, prostate or lung, heart disease is a competing concern, and it's because of these medications," said Novant Health cardiologist Dr. Kris Swiger, a pioneer in a new and growing medical subspecialty called cardio-oncology. About 40% of his Wilmington practice is devoted to treating and preventing heart disease in cancer patients.
Many are now living longer than ever before. But side effects such as heart failure, blood clots, abnormal heart rhythms and coronary artery disease can crop up during cancer treatment or even long after. Chemotherapy also causes fatigue and a loss of muscle mass and endurance.
"It compounds an already difficult journey," Swiger said.
Heart care starts with your PCP.
That's why Novant Health Zimmer Cancer Institute has launched a 12-week cardiac rehab program for cancer patients. Part of a coordinated approach to cancer care involving both oncologists and heart specialists, it's modeled on the rehabilitation that has long been prescribed after a heart attack or open-heart surgery.
The program — jointly endorsed by the American Heart Association and the American Cancer Society — is called CORE, short for Cardio-Oncology REhab. It aims to prevent or lessen heart damage, and to help cancer survivors regain their stamina, endurance and confidence. In some cases, patients who benefit have are found to have no heart issues at all.
Besides a tailored biometric exercise program, two 90-minute sessions a week teach participants healthy habits — for instance, how to control blood sugar, manage stress, improve their diet and sleep better. There's also peer support from other patients who are going through the same thing.
‘I was a hot mess’
One of the first to benefit from CORE is Anna Kareiva, 44, a Wilmington music therapist diagnosed last fall with an aggressive form of breast cancer.
Kareiva, who had missed her mammogram during the pandemic, discovered her tumor by chance. When her then 4-year-old daughter, Willow Rose, tired during a walk, Kareiva scooped her up and felt a sudden pain in her chest. A self-exam later that "just felt wrong" sent her rushing to the doctor.
The diagnosis: triple negative breast cancer or TNBC. Kareiva's cancer was stage 4 — tumors in her right breast had spread to her lymph nodes and scans revealed lesions on her liver and her brain.
"For me to be so young and never have anything medical other than my wisdom teeth taken out, it was a shock," she said.
Because TNBC tends to grow and spread faster than some cancers, Kareiva's treatment has been aggressive. Since last fall, she has had a mastectomy, breast reconstruction, chemo and radiation, and she's now receiving infusions of a potent immunotherapy drug called Keytruda every six weeks.
While her prognosis is good, her treatment has taken a toll.
Over time, Kareiva developed neuropathy in her hands and feet. She could no longer play her guitar or even use a dinner knife. Her balance was wobbly. She was sometimes so short of breath that she struggled to pick up her little girl. She quit work and grew sedentary, anxious and depressed.
"I was a hot mess," she recalled.
Concerned Kareiva might have heart problems, a friend at Novant Health referred her to Swiger and CORE. Cardiac testing offered the reassurance she needed that she was experiencing typical chemo side effects. Her heart was OK.
"I think doubt becomes a part of the journey," Kareiva said. "You need people on the journey to encourage you."
Besides Swiger and the CORE team, Kareiva has received big doses of encouragement from fellow participants — cancer patients who relate to her feelings because they're living through the same things.
Thanks to CORE, Kareiva said she understands better now how to take care of herself, the importance of staying active and feeding both body and soul. She works out on a treadmill at home, following an exercise program from CORE. She enjoys trying new recipes for nourishing broths and smoothies and makes sure she has healthy ingredients on hand.
"The nutritionist was pivotal for me in sharing how to meal plan for my needs, for nutrition and for anxiety," Kareiva said. "She broke it down real simple and said, 'these are the things that are going to sustain your energy.' We weren't eating regularly in a way that would make me feel good."
Now that she feels better, Kareiva has started putting her music therapy and counseling skills to work again, helping other musicians overcome setbacks and get back in the game.
Recently, she has become active in Voice & the Pen, a showcase for local singers and songwriters held in Wilmington and online. Besides interviewing performers, she shares some of her original songs about grief on the Wednesday evening program. See a link of a performance of hers here at 1:28:44
Her cancer journey isn't over, but she has a fresh perspective now.
"The CORE program was there to help me intellectually and physically grasp that my baseline was somewhere else now — and that my recovery was more hopeful than I could sense," Kareiva said. "It's about launching you and leaving with clarity."
Enrollment growing fast
Enrollment in CORE is projected to double to 50 patients this fall, Swiger said. Participants are referred by their oncologists.
Unlike rehab for heart patients, CORE is not yet covered by insurance. Participants are asked to chip in about $40 a month if they can. But, Swiger said, "if there's even a bit of hesitation in their voice, we say 'don't worry about it.' " Funding from grants will pick up the tab.
"We really believe this is important, and we see the positive effect it has on folks," he said, "So at this point we're very happy to subsidize it."
Novant Health cardio-oncology services
Novant Health's cancer and heart specialists work together to prevent and treat heart-related issues during cancer care across North Carolina. You may be referred to cardio-oncology experts:
- If you already have heart disease and need cancer treatment.
- For evaluation and testing before beginning cancer treatments that pose risks to the heart.
- For heart and wellness rehabilitation and lifestyle adjustments during cancer care.
- For monitoring and treatment of cardiovascular complications after cancer therapy.
To make it easier for cancer patients to get needed cardiac care, cardiologists from Novant Health Heart & Vascular Institute provide services on-site at Novant Health Zimmer Cancer Institute.
Cancer by the numbers
1 - About 2,500 people a year are diagnosed with cancer in the seven-county region served by Wilmington's Novant Health New Hanover Medical Center.
2 - The National Cancer Institute estimates there are 18.1 million cancer survivors in the U.S. — about 5.4% of the population. That's expected to increase to 22.5 million by 2032.
3 - The odds of developing risk of heart disease risk factors such as high blood pressure, diabetes and elevated blood levels of cholesterol and fat increase eighteenfold for patients who live at least five years after their cancer diagnosis.
4 - Being physically active helps lower the risk for cancers of the bladder, breast, colon, uterine lining, esophagus, kidney, lung and stomach.
5 - In patients who have cancer, exercise may help reduce the risk of recurrence.