Complementing Markey's world-class care

The new cardio-oncology and onco-nephrology services at UK HealthCare ensure that cancer patients receive the most comprehensive care possible.

Cancer treatments are designed to eradicate cancer, but sometimes these potentially life-saving therapies can have negative, unintended consequences on other parts of the body, like the heart and kidneys.

That’s why the UK Markey Cancer Center is complementing its world-class care with two new services: cardio-oncology and onco-nephrology. When cancer patients develop heart or kidney issues alongside their treatments, UK HealthCare’s experienced cardio-oncologists and onco-nephrologists collaborate closely with oncologists to provide the most comprehensive care.

Because of this teamwork, patients don’t have to forgo leading-edge cancer treatments for fear that heart or kidney problems will develop or worsen. The providers of these two subspecialties work hand-in-hand with Markey’s specialists to minimize these risks as much as possible.

Cardio-oncology

UK HealthCare’s cardio-oncology service launched in 2020. Cardiologist Dr. Amit Arbune leads the program, with the support of a cardiology nurse practitioner, a nurse coordinator and a dedicated medical assistant.

“We need to make sure their hearts are able to tolerate the chemotherapy and protect them from potential cardiac side effects.”

Dr. Amit Arbune

Cancer treatment-induced heart problems affect nearly 10 percent of cancer patients. These problems, including conditions known as cardiotoxicity, can be caused by chemotherapy, immunotherapy or radiation therapy. Symptoms of these health issues can develop immediately during treatment, or they can develop decades after cancer survivors complete treatment. When undiagnosed, these issues can be a major cause of morbidity or death for cancer survivors. Therefore, it is essential to detect and treat these cancer-induced issues.

“The patients we see at Markey are already complex patients who may have comorbidities, so they need to have the best chemotherapy for their cancer,” Arbune said. “But at the same time, we need to make sure their hearts are able to tolerate the chemotherapy and protect them from potential cardiac side effects.”

All patients undergo rigorous screening for cardiovascular risk prior to cancer treatment. In addition to locating the cancer, providers must ensure the patient’s heart is healthy enough to endure the treatment.

A vital part of this program is the access to best-in-class imaging modalities, including cardiac MRI and cardiac CT scans as well as echocardiograms.

“We’re able to follow patients while they’re receiving chemotherapy to make sure they don’t develop side effects,” Arbune said. “If they do, we’re able to diagnose it early.”

The cardio-oncologist and oncologist jointly develop a thorough treatment plan for their patients with the goal of destroying the cancer while preserving heart function.

Throughout cancer treatment and beyond, patients visit the cardio-oncologist to help ensure early detection of any change in heart health. Other risk factors, including high blood pressure, may also be managed by the cardiooncologist.

“We need to be patients’ best hope for cancer care as well as cardiac care,” Arbune said.

Onco-nephrology

UK HealthCare began offering onco-nephrology services in 2022. This is the only clinic in Kentucky that offers this much-needed, specialized care.

“The complexity of the field underscores the need for a welldefined, multidisciplinary approach led by a dedicated team to ensure the highest quality care,” said Dr. Taha Ayach, director of the onco-nephrology program.

Kidney disease is a frequent and increasing complication in cancer patients. It’s estimated that almost one-third of cancer patients have some degree of kidney dysfunction.

“The nephrology providers collaborate closely with the oncologists to help guide this coordinated care so that patients can continue to get the life-changing treatment they need.”

Dr. Taha Ayach

Cancer itself can directly injure the kidneys through tumor infiltration or production of nephrotoxic substances. Additionally, cancer treatment can harm kidneys as some new targeted therapeutic drugs and intensive chemotherapy regimens are nephrotoxic.

Patients with underlying chronic kidney disease have limited options for cancer therapies due to their decreased renal function. Chronic kidney disease may already be present in a substantial number of patients before a cancer diagnosis. This is likely because of comorbid conditions, such as diabetes and hypertension, that are highly prevalent in the population.

Having chronic kidney disease impacts the efficacy of chemotherapy and may increase the risk of side effects as well. The onco-nephrology team can therefore carefully tailor their care so that patients are able to reap the most benefits from their treatment and get on the road to recovery.

“The nephrology providers collaborate closely with the oncologists to help guide this coordinated care so that patients can continue to get the life-changing treatment they need,” Ayach said.