Q: How did you get into medicine? And why cardiology?
A: In my family, many people are already in medicine, so it was kind of like the family profession in some ways. They were all quite famous doctors as well. So, me and my brother, growing up, it was very much, well, you’ll just become doctors. I have to say that I don’t have any regrets in the way things have turned out!
I think the reason I went into Cardio-Oncology is every day is a new day. Once I was in medicine, I found different specialties in medicine interesting, but I found cardiology the most interesting. Because it is such a new field, really nothing is set in stone. In practice, what that means is that you have to develop new services, you have to innovate, you have to think outside the box on a daily basis. If you look at some of the more mature specialties within medicine, many things have already been done and very established pathways and management practises already exist. These can be difficult to change or challenge even when improvements are required.
Q: What is Cardio-Oncology? Is it a new area of medicine?
A: Cardio-Oncology has probably only really been around for 15 years at the most, I would say. In medicine, we’re talking about things having existed for decades, so from that point of view, definitely it’s still new. In the simplest of terms, Cardio-Oncology is the cardiac care of cancer patients. This care can be because a cancer patient has pre-existing heart disease, or it can be that the treatment that’s offered to a cancer patient may potentially cause heart disease, or it can also be directed to a cancer patient who’s finished treatment and has, as a result, developed heart disease. So, those are the three kind of categories of patients, before, during and after treatment. Cardio-Oncology encompasses that full holistic approach to managing those patients across the length of their cancer journey. A small part of my work is actually cancer of the heart, which makes up a small component of Cardio-Oncology. The vast part of Cardio-Oncology is not cancer directly in the heart, as it were, but cancer treatment, affecting the heart.
Q: Can you tell us about your role at The London Clinic?
A: I run the Cardio-Oncology service at The London Clinic. So, cancer patients who come into The London Clinic, if they have cardiac issues, they are identified and then they’re referred to my clinic. Cancer patients at The London Clinic can be confident that their heart issues will be assessed and will be addressed appropriately. So that is something that is specific to The London Clinic.
I also helped set up Cardio-Oncology services at UCLH (Europe’s largest haemato-oncology centre) and at Bart’s Heart Centre (Europe’s largest cardiac centre) and I run these services at UCLH. And alongside that, I’m a Professor of Cardiology at QMUL, Queen Mary University of London, which is associated with Barts Heart Centre. So those are my clinical roles.
In terms of the cardiology service at The London Clinic, I see patients with any kind of cancer with any heart issue. Alongside that, I of course see general cardiology patients as well who don’t have cancer, which is also part of my day job. Patients who have chest pain or palpitations or shortness of breath who don’t have cancer, I of course see those patients as well. When it comes to my roles at Barts and UCH, it is very similar.
I’m also involved in a number of research projects on the Cardio-Oncology side as part of my role as being Professor of Cardiology. And I have a number of educational and leadership roles as well. I wrote the Cardio-Oncology part of the curriculum for cardiology trainees in the UK, so all cardiology trainees are mandated to learn about Cardio-Oncology, which is of course a very good way to ensure that all cardiologists of the future have some exposure to Cardio-Oncology. They don’t have to become Cardio-Oncologists, but they need to have an understanding of how cancer treatments can affect the heart. I am also on the boards of many international Cardio-Oncology organisations and wrote the first UK guidelines on Cardio-Oncology.
