In June 2021, The Kinetix Group interviewed Dr. Carrie Lenneman, a cardiologist who specializes in working with cancer patients who have a higher-than-normal risk that their cancer treatment may affect their heart. She also works with patients who have had previous cancer treatment and are experiencing symptoms that may be related to their prior treatment. Dr. Lenneman is Medical Director of the Cardio-Oncology Clinic at the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB) in Birmingham, Alabama.
Cardio-oncology is a subspecialty area of cancer care that has become increasingly important as the number of long-term cancer survivors continues to go up. Advancements in cancer therapies have tremendously improved the long-term survival of patients. However, some of the treatments can be hard on the heart, especially for those individuals who may have other medical conditions, or who have sensitivities to their therapies.
What follows is Part 1 of a transcript of our interview with Dr. Lenneman, edited for this format.
| Warren Smedley: | Today’s special guest is a former colleague from the University of Alabama at Birmingham Health System, Dr. Carrie Lenneman. Dr. Lenneman is Director of the UAB Cardio-Oncology program at the O’Neal Comprehensive Cancer Center at UAB. Dr. Lenneman, can you begin by giving us an overview of what your subspecialty of cardio-oncology does and what niche it’s filling, especially for long-term cancer survivors? |
| Dr. Lenneman: | Absolutely. Cardio-oncology is still a relatively new field which sort of began in the early 2000s and arose from the fact that patients are living longer, and cancer treatment may have long-term effects on the body. Cancer has become more of a chronic disease, and patients are living many healthy years following treatment. In general, the number of cancer survivors is continuing to increase. It’s one of the largest groups of patients who now know how to access the healthcare system, making cancer survivors one of the largest groups of patients that we interact with on a regular basis. It’s really important to understand the treatments that a patient may have been exposed to because there are truly long-term cardiovascular effects that may begin to appear 5, 10, 15, or 20 years after treatment, and these may impact their overall health and their ability to have a normal and good quality of life. Anthracyclines are probably the most common medications that are used for lymphomas, sarcomas, breast cancer, and leukemias. We began to realize in the 1960s that those treatments had cardiotoxic exposure, increasing the risk of heart failure, that was very dose dependent. So that sort of kicked off the field of cardio-oncology. But now we know there are a growing variety of targeted therapies that are having off-target effects on the cardiovascular system, such as tyrosine kinase inhibitors and anti-VEGF inhibitors. We now know that immune checkpoint inhibitors, all these targeted therapies, can have undesirable effects on, not only the heart, but also on the vascular system. And it is important to know the long-term vascular effects of these medications. |
| Warren Smedley: | Dr. Lenneman, you’re trained as a cardiologist. How does a cardiologist fit into the oncology team? |
| Dr. Lenneman: | That’s a great question. So, like you said, I am a trained cardiologist. I came into cardio-oncology actually through research because I was very interested in understanding how can we predict better for breast cancer patients who will develop heart failure after exposure to either anthracyclines or trastuzumab. So I sort of fell into this field via the way of research and just love the patient population. This is a field that requires constant communication with patients’ oncologists. It has become truly a collaboration where we seek to identify patients that might be at high risk for developing heart failure and devise a strategy on how to best monitor them with more increased frequent cardiac echoes or biomarkers. We also seek to optimize their baseline risk factors, such as blood pressure, diabetes, weight, and exercise. All of these things have important implications for how they will do as they go through treatment, as well as on how they will do in survivorship. |
| Warren Smedley: | Now, you and I worked together when you first came to UAB, and you were the very first cardio-oncologist in the State of Alabama. So the field has been growing, especially in some of the smaller states like Alabama. What has happened over the last couple of years? How has this subspecialty grown across the country? |
| Dr. Lenneman: | Cardio-oncology has definitely grown. We’ve increased awareness, not only here at UAB across our campus at Birmingham, but I’ve also had a collaborator at USA in Mobile, who began practicing cardio-oncology by personal interest. Together we have been collaborating on patients who are in the southern part of the state, so that we are having a better breadth and better coverage of our patients in Alabama. So that’s our goal: to grow this program and increase awareness across the state. We also work with other providers who have an interest in this field, which has been great. |
| Warren Smedley: | What kind of patient population do we have? Is it a large patient population? How many patients typically need to have a consult with a cardio-oncologist? |
| Dr. Lenneman: | I can give you some examples. Last week we saw over 40 patients. Eight of those were new and 20 of those were returns, and we generally hold clinic four half days a week. It’s a busy clinic. We also read echocardiograms and do things like that for our shared patient population. So we stay pretty busy, actually. |