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Protecting the heart during cancer treatment
Sentara's Cardio-Oncology Program addresses the cardiovascular effects of cancer therapies
Zackary Tushak, D.O., was recruited to Sentara three-and-a-half years ago from Pennsylvania, initially joining the system as an advanced heart failure and transplant cardiologist. Along with that expertise, he brought a deep passion for cardio-oncology, a growing specialty focused on the intersection of cancer treatment and cardiovascular health.
Recognizing a critical need, Dr. Tushak helped establish the Cardio-Oncology Program at Sentara Heart Hospital, creating a comprehensive approach to protecting patients’ hearts before, during, and long after cancer treatment.
Cardio-oncology addresses the cardiovascular effects of cancer therapies, particularly chemotherapy, which can place stress on the heart. At Sentara, the program is structured around three clearly defined phases of care.
The second phase occurs during active cancer treatment. Patients may be referred to the cardio-oncology program either proactively or after experiencing an adverse cardiac reaction to therapy. These reactions can include arrhythmias, chest pain, or even heart failure. During this phase, the goal is to evaluate and treat cardiovascular issues so patients can safely tolerate and complete their cancer treatment.
The third phase is survivorship. Advances in oncology over the past two decades have significantly improved survival rates, resulting in a growing population of cancer survivors, now estimated at more than 15.5 million nationwide. While many patients do well during treatment, survivors remain at an increased long-term risk of cardiovascular disease, including heart failure. Patients in this phase are monitored closely, as their lifetime risk of developing heart failure is approximately 1.8 percent.
HER2-targeted therapies increase oxidative stress in the heart and disrupt cellular signaling. Importantly, the cardiac damage caused by these agents is often reversible, meaning heart function can improve once the medication is stopped.
Anthracycline agents, by contrast, also cause oxidative stress but directly damage DNA within heart cells. This damage is considered irreversible and may not lead to symptoms for many years. Over time, however, the accumulated injury can result in heart dysfunction or clinical heart failure.
Overall, clinical heart failure develops in approximately 2-5% percent of patients who receive chemotherapy. As newer agents with fewer side effects and lower dosing strategies are introduced, those rates continue to decline. Patients with preexisting cardiovascular disease, such as coronary artery disease, arrhythmias, or prior heart failure, as well as risk factors like uncontrolled high blood pressure, diabetes, and elevated cholesterol, are more susceptible to cardiotoxic effects.
Recognizing cardiotoxicity can be challenging, as symptoms such as shortness of breath, fatigue, swelling, and nausea may overlap with common side effects of chemotherapy. For this reason, oncologists and cardiologists work closely together to monitor patients and identify signs of emerging heart failure as early as possible.
At Sentara, the cardio-oncology program collaborates closely with Virginia Oncology Associates, allowing for rapid referrals and coordinated care. Patients receiving HER2-targeted or anthracycline therapies are screened regardless of age. Programs like Sentara’s are typically found at large healthcare centers due to the specialized expertise required.
“The last thing a patient battling cancer should have to worry about is their heart,” Dr. Tushak tells his patients. “Don’t worry about your heart. Let me worry about that. I’ll work with your oncologist so you can complete your treatment and get back to living your life.”
Dr. Tushak emphasizes that patients should not be afraid of chemotherapy. While cardiotoxicity is a serious potential complication, it remains relatively uncommon. Following oncologists’ recommendations and participating in appropriate cardiac surveillance allows risks to be identified and managed early.
Above all, Dr. Tushak encourages patients to advocate for themselves. If something feels wrong or symptoms arise, speaking up can make all the difference. With a robust surveillance protocol and a dedicated cardio-oncology team, Sentara Health is ensuring that patients fighting cancer do not have to fight heart disease alone.
You can learn more about Sentara’s Cardio-Oncology Program here: Cardio-Oncology
Recognizing a critical need, Dr. Tushak helped establish the Cardio-Oncology Program at Sentara Heart Hospital, creating a comprehensive approach to protecting patients’ hearts before, during, and long after cancer treatment.
Cardio-oncology addresses the cardiovascular effects of cancer therapies, particularly chemotherapy, which can place stress on the heart. At Sentara, the program is structured around three clearly defined phases of care.
Sentara’s three phases of cardio-oncology care
The first phase focuses on identifying and optimizing preexisting cardiovascular conditions. Patients are screened for issues such as heart dysfunction, coronary artery disease, or high blood pressure before beginning chemotherapy. Because certain cancer treatments can worsen these conditions, addressing them early helps reduce the risk of complications once treatment begins.The second phase occurs during active cancer treatment. Patients may be referred to the cardio-oncology program either proactively or after experiencing an adverse cardiac reaction to therapy. These reactions can include arrhythmias, chest pain, or even heart failure. During this phase, the goal is to evaluate and treat cardiovascular issues so patients can safely tolerate and complete their cancer treatment.
The third phase is survivorship. Advances in oncology over the past two decades have significantly improved survival rates, resulting in a growing population of cancer survivors, now estimated at more than 15.5 million nationwide. While many patients do well during treatment, survivors remain at an increased long-term risk of cardiovascular disease, including heart failure. Patients in this phase are monitored closely, as their lifetime risk of developing heart failure is approximately 1.8 percent.
How certain cancer treatments can lead to heart complications
Different cancer treatments affect the heart in different ways. Some therapies have minimal cardiac impact, while others can lead to complications such as arrhythmias, chest pain, blood clots, or heart failure. Two major classes of chemotherapy agents are most commonly associated with heart failure, particularly in patients treated for breast cancer: HER2-targeted agents and anthracycline agents.HER2-targeted therapies increase oxidative stress in the heart and disrupt cellular signaling. Importantly, the cardiac damage caused by these agents is often reversible, meaning heart function can improve once the medication is stopped.
Anthracycline agents, by contrast, also cause oxidative stress but directly damage DNA within heart cells. This damage is considered irreversible and may not lead to symptoms for many years. Over time, however, the accumulated injury can result in heart dysfunction or clinical heart failure.
Monitoring heart function and recognizing cardiotoxicity
Patients treated with anthracyclines are routinely monitored with echocardiograms to assess heart function. If heart failure develops, they are referred to Sentara’s Heart Failure Clinic, where a multidisciplinary team works to protect heart function, improve symptoms, and maintain quality of life. Because cardiotoxic effects can emerge even a decade after treatment, these patients are monitored for life.Overall, clinical heart failure develops in approximately 2-5% percent of patients who receive chemotherapy. As newer agents with fewer side effects and lower dosing strategies are introduced, those rates continue to decline. Patients with preexisting cardiovascular disease, such as coronary artery disease, arrhythmias, or prior heart failure, as well as risk factors like uncontrolled high blood pressure, diabetes, and elevated cholesterol, are more susceptible to cardiotoxic effects.
Recognizing cardiotoxicity can be challenging, as symptoms such as shortness of breath, fatigue, swelling, and nausea may overlap with common side effects of chemotherapy. For this reason, oncologists and cardiologists work closely together to monitor patients and identify signs of emerging heart failure as early as possible.
At Sentara, the cardio-oncology program collaborates closely with Virginia Oncology Associates, allowing for rapid referrals and coordinated care. Patients receiving HER2-targeted or anthracycline therapies are screened regardless of age. Programs like Sentara’s are typically found at large healthcare centers due to the specialized expertise required.
Following oncologists’ recommendations
Since Dr. Tushak helped launch the program, an average of 100 patients per year have visited the Heart Failure Clinic for ongoing care. Management may include observation, medication, advanced imaging, or a combination of therapies tailored to each patient’s needs.“The last thing a patient battling cancer should have to worry about is their heart,” Dr. Tushak tells his patients. “Don’t worry about your heart. Let me worry about that. I’ll work with your oncologist so you can complete your treatment and get back to living your life.”
Dr. Tushak emphasizes that patients should not be afraid of chemotherapy. While cardiotoxicity is a serious potential complication, it remains relatively uncommon. Following oncologists’ recommendations and participating in appropriate cardiac surveillance allows risks to be identified and managed early.
Above all, Dr. Tushak encourages patients to advocate for themselves. If something feels wrong or symptoms arise, speaking up can make all the difference. With a robust surveillance protocol and a dedicated cardio-oncology team, Sentara Health is ensuring that patients fighting cancer do not have to fight heart disease alone.
You can learn more about Sentara’s Cardio-Oncology Program here: Cardio-Oncology