About two years after I finished chemotherapy, surgery, and radiation to treat inflammatory breast cancer, I started having trouble with shortness of breath. Horrible coughing fits shook my body. When I couldn't breathe, I could feel my heart rate increase.
The first thing my doctor did was to check me out to make sure the cancer had not metastasized to my lungs. Good news! Clear lungs!
The next referral surprised me. The doctor sent me to the cardiologist. Maybe I was short of breath because my heart was not working properly. Once I stopped to think about it, I realized that I should have thought about heart problems sooner. After all, the consent forms I had signed for both my chemo and radiation mentioned possible heart side effects. My radiation oncologist and I had discussed whether I should have extra radiation to the lymph nodes under the sternum right above the heart. I decided it was more important to live long enough to have side effects and told her I wanted the most aggressive treatment.
Now I was sitting in the cardiologist's office wondering if I had made the right choice. When the cardiologist assured me that any heart issues I might be having currently could not be related to treatments I had two years earlier, I was not assured. I knew that I was slipping between the cracks of medical specialization. The cardiologist did not know anything about side effects from cancer treatments, and my oncologists did not know much about hearts. Fortunately, it turned out that my heart was not the problem.
A recent article by Zosia Chustecka for Medscape indicates that I am not the only person to be caught between medical specialties. Chustecka reports, "Some of the new anticancer drugs are so effective that they can keep tumors in check; ironically, it is their adverse effects on the heart that can threaten to cut life short. A death from therapy-related heart failure in a patient whose cancer is in remission is the ultimate irony-a deathblow from collateral damage while the war on cancer is being won."
This problem has led to the development of a new specialty, cardioncology. So far there is not special training or board certification for doctors who want to specialize in treating heart problems related to cancer. However, last year interested doctors formed the International Society of Cardioncology while meeting at a conference in Milan, Italy. This year the society met in Nashville, Tennessee, for a symposium dedicated to educating doctors on the topic and building partnerships between oncologists and cardiologists.
The key is to get the specialties talking to each other-not always a habit of busy doctors who read their own journals about their own specialties, but who often do not know much about progress being made in other fields. Another problem is the way clinical trials are set up. Cardiologists do not know for sure if the standard treatment for certain types of heart problems will work on cancer patients because the trials usually exclude people with a history of cancer. Oncologists are often not sure if a standard treatment for cancer should be administered to a woman with a history of heart problems because the research excludes women with heart problems from studies on cancer drugs.