Heart outcomes improving for cancer patients

Advances in the number of available cancer therapies will mean an increase in the already significant number of potential side effects on the heart caused by current cancer therapies.

Area cancer patients who undergo treatments that may adversely affect the heart can receive specialized care through a cardio-oncology program offered by collaborating cardiologists and oncologists at The University of Kansas Hospital and The University of Kansas Cancer Center.

"Rather than withhold a lifesaving drug because of its toxicity on the patient's heart, we work together to see if we can modify the treatment to support the heart, so the patient can continue therapy," said Charles Porter, MD, medical director of the program.

By developing protocols and strategies for improving heart outcomes for cancer patients, the group has become a national leader in the evolving field of cardio-oncology, Dr. Porter noted.

Keeping Pace with Diane

Diane PunchTo look at Diane Punch, who's always on the go with a breezy attitude and a jam-packed schedule, you wouldn't guess she's ever suffered more than a hangnail. Instead, she's survived medical conditions that twice nearly claimed her life.

In an arduous medical journey spanning fewer than 15 years, she's lived through:

  • The birth of a son so critically ill he wasn't expected to survive an hour.
  • Stage III non-Hodgkin lymphoma with a grapefruit-sized chest tumor.
  • Intensive chemotherapies and extensive radiation therapy.
  • A stem cell transplant with high-dose chemotherapy.
  • A serious allergic reaction to transplant-related medications.
  • A mild stroke with some vision loss.
  • Severe, undetected heart damage that became life-threatening.
  • Surgery to implant a specialized pacemaker.

"When I had advanced-stage cancer in 2002, doctors told my husband to make sure my will was in order," Diane remembered.

A series of aggressive cancer treatments ultimately saved her life. Cancer-free since 2003, Diane appeared to be in perfect health for years – the ideal survivor of an advanced-stage cancer.

Then one day in 2012, she reached up for something in a bedroom closet and a split second later, the world no longer quite made sense. Suspecting a stroke, husband Doug rushed her to the nearest emergency room, where she was misdiagnosed with a migraine and anxiety and sent home with ibuprofen.

She appealed to her primary care doctor, who prescribed anti-anxiety drugs.

Enormously frustrated, dizzy and still without full vision, Diane sought answers at The University of Kansas Hospital. Scans confirmed a stroke with no apparent cause. Not satisfied, neurologists referred her to a cardiology workup with Ryan Ferrell, MD, at the hospital's Center for Advanced Heart Care.

Subsequent test results shocked the Punches: Diane's heart was barely functioning.

"Her heart muscle was severely weakened. Her ejection fraction, an estimate of how well the heart pumps blood, was less than 10 percent," Dr. Ferrell said. "Normal ejection fractions range from 55 to 65 percent in most people. Less than 30 percent is considered severely impaired. As a result, a blood clot formed in her heart, causing the stroke."

Diane was in disbelief. "Before my stem cell transplant in 2003, I'd had pretty extensive heart tests and was good to go."

Most likely, Diane had developed severe heart damage as a residual effect of the lifesaving cancer treatments she received a decade before.

"So much less was known back then about the extent to which some commonly used cancer therapies are toxic to the heart," Dr. Ferrell said.

The field of cardio-oncology barely existed in 2002. But today, The University of Kansas Hospital's cardio-oncology program helps improve heart outcomes for patients undergoing certain types of cancer treatments.

Since 2013, Diane's once dire heart condition has been successfully managed with a three-lead pacemaker to regulate the rhythm of both sides of her heart, as well as a regimen of heart medications and close monitoring by her cardiology team.

"Dr. Ferrell is fantastic," she said, "and we've been so impressed with the whole cardiology group. They're attuned to my other health issues, move very quickly and are on the front end of the newest medications."

Ever an overachiever, Diane leads what she calls "a completely normal life." To her, this means a full-time job for a technology firm, weeknight piano lessons for her nine students, seven to 10 hours each weekend on staff in a children's ministry, and being a wife and mother of three. Survivorship apparently runs in the Punch family. That medically fragile infant? He's a strapping 13-year-old football player and cellist.