The old adage “the cure is worse than the disease” doesn’t quite apply to cancer. But chemotherapy and radiation can take a real toll on the body. Long after the cancer is gone, the aftereffects of treatment can linger.
It’s especially cruel that chemo can exacerbate heart and blood pressure conditions, but it’s a reality. It’s why some cancer patients may be referred to a cardiologist before they begin treatment or after they’re finished.
Dr. Kris Swiger, a cardio-oncologist with Cape Fear Heart Associates, part of NHRMC Physician Group, in Wilmington, prefers to meet patients early in the treatment process. But he’s there for “every step of the journey.”
“I see people when they're first diagnosed with cancer,” he said, “to help optimize their heart going into chemotherapy. I see people while they're receiving chemotherapy, if they experience side effects that impact the heart, which is fairly common. And I see a lot of survivors who have finished treatment who, at that point, need to shift focus to preventing heart disease. We focus on wellness and getting their endurance back.”
Three years ago, Swiger started Wilmington’s first cardio-oncology program. And in the past year, he began a cardio-oncology rehabilitation program, which helps patients with cancer become stronger. Sometimes, patients need to go through cardiac rehab to get strong enough to tolerate chemo.
In October, he began seeing patients at Novant Health Zimmer Cancer Institute, located at New Hanover Regional Medical Center, instead of at the previous off-site location. It’s more convenient for patients, and it enhances coordination with the oncology team. It’s the same model Swiger was part of during his training at Vanderbilt and Johns Hopkins.
“Fighting cancer is awful,” Swiger said. “If you don't have to drive to a different building to have ultrasounds of your heart, it’s one less stop you have to make. A one-stop shop is just easier for patients. Plus, it’s easier for me to consult with oncologists who are right upstairs. Connecting face-to-face is always better than a phone call.”
Cancer treatment ‘renaissance’
“We're in a cancer therapeutics renaissance,” Swiger said. “In the last 10 years, we've had all these new medications that have turned a lot of cancers that were seen as death sentences into chronic diseases and have really given people a chance. But a lot of these medicines – the new targeted therapies – injure the heart in different ways.”
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So there's been a trend to involve cardiologists to make sure that patients don't have any side effects, or at least control them, he said. And if they do, we can manage them so the patient can finish their chemotherapy. That’s the goal: Get rid of the cancer.”
Medicines – even aspirin – can have side effects, and the side effects of chemo can be serious. “Some of the newer medicines can cause clots in your arteries or veins while others can cause arrhythmias – fast or slow heart rates,” Swiger said.
“The folks more likely to have their heart muscle become damaged are those who already have stressors on the heart – high blood pressure, diabetes, people who smoke. If you're going into chemotherapy with a heart that's vulnerable, then you're more likely to have complications.”
In Wilmington, “we started a three-month-long cardio-oncology rehab program for cancer survivors,” Swiger said. “This was something the American Heart Association and the American Cancer Society recommended for cancer survivors who often feel worn down. A post-chemo cardiac rehab program helps patients regain stamina and endurance. We help with nutrition and offer yoga, an exercise program, mindfulness training.
“Especially now in the pandemic, this has been one of the few places survivors can come together to share their stories,” he continued. “We've had a lot of success with this rehab program. People who go through it seem to gain a lot of physical and mental wellness from it.” A similar program in Charlotte has also had great success.
“There's data that suggests that going through an exercise regime after cancer prevents cancer from coming back,” he added. “The theory is that if you're not frail – if you're kind of a robust person who can tolerate exercise – that maybe your immune system can also be stronger and fight off cancer.”
‘Side effects … worse than cancer’How did Swiger get into this field? “In medical school, I always loved cancer patients because they gear up to fight their disease – more than any other disease,” he said. “Cancer patients see cancer as this enemy, and the community rallies around them. They’re really motivated.”
In addition, Swiger’s uncle had breast cancer. “He experienced a lot of heart side effects while he was receiving treatment,” Swiger said. “This was more than 10 years ago, but I remember he was left with these effects that are in some ways worse than the cancer he had.”
You might expect a cardo-oncologist to see links between cancer and heart disease, and Swiger does. “Cancer isn’t always a random event that just happens to people,” he said.
“The truth is: It’s a lot like heart disease. There are a lot of lifestyle risk factors that can put you at higher risk of cancer. The type of foods we eat, our weight, whether or not we have diabetes – these are risk factors for heart disease, but they're also risk factors for (some types of) cancer. The No. 1 and No. 2 two killers in the United States are heart disease and cancer. I think most of us view these as two different disease buckets, but they are really quite related.”