Daniel Lenihan, MD, is a cardio-oncologist who specializes in cardiology, heart disease and advanced heart failure/cardiac transplant. His areas of interest include cardiotoxicity of cancer therapy, early phase clinical trials, amyloidosis, cardiomyopathy and cancer survivorship.
Your specialty is quite unusual, how did you come to be a cardio-oncologist?
My background is in advanced heart failure. Years ago when I accepted a position at MD Anderson Cancer Center in Houston, my expertise in heart failure was discovered to be very useful. A high percentage of our patients with cancer were developing cardiac problems while they were getting more aggressive treatments for cancer. Because of this cardiac toxicity (damage to the heart caused by harmful chemicals as a result of cancer treatments), it became obvious I needed to explore cardio-oncology as a specialty.
Does the toxicity occur because of the cancer treatments?
It’s always a challenge to define the exact source of any problem — especially in people who may have heart failure or other cardiac issues. It could have been a heart condition that previously existed, but wasn’t known about, or it could be the result of the cancer treatment.
Most of the time you have to be a detective to determine what health conditions existed before or what may have resulted from the cancer treatment. A patient might have had an existing heart condition, and if that condition had been managed better, there would not have been any toxicity from the cancer treatments.
You have to figure out the cause of the problem and choose the best treatments for your patient.
When the cancer treatments stop, do the heart problems typically go away?
Not always. Radiation therapy can have cardiac manifestations many years later – depending on the type of cancer and its location.
Because of tremendous advancements over the last 10-20 years, cancer treatments are so much more successful today and patients are living longer. If the upside is improved survival, the downside is we are seeing these cardiovascular manifestations and toxicities because patients haven’t succumbed to the cancer, as they might have in the past.
What brought you to Washington University?
When I was at MD Anderson Cancer Center in Houston, one of my colleagues was Dr. Doug Mann – who is now chief of cardiology here at Washington University. As the years went by and my interest and experience in cardio-oncology grew, I left Texas to develop a cardio-oncology program at Vanderbilt in Nashville. Dr. Mann recognized that this type of program would be an important addition to the landscape at Washington University and he asked me to consider coming here.
When someone you admire asks you to work for him, it is an easy decision. And that is how I ended up here.
Which aspect of your practice is most interesting?
There are so many interesting scientific aspects of my practice, and because new therapies are continuously coming on board, the potential cardiac manifestations always have to be considered.
The most compelling piece for me has always been patients and their stories. I am motivated to protect my patients from the many treatment toxicities they may get, but at the same time I try to assist the oncologist to make sure the cancer treatment is the best the patient can possibly get. Minimizing the cardiac impact is the best case scenario.
What new developments in your field are you most excited about?
There are many developments I am excited about — especially in the way oncology treatments have become more targeted. The treatments can now focus in on a particular cancer cell or mechanism of how cancer cells develop.
These cancer drugs are intended to be very specific, but unfortunately there are common mechanisms shared by cancer cells and heart cells. So if you give a cancer-limiting drug that blocks a certain pathway in a cancer cell, we found over the years, that there are many similar tissues in the cardiovascular system.
The fascinating outcome of developing drugs that block certain pathways is that we have been able to develop cardiac treatments because of what we have learned from the cancer drugs that targeted a particular mechanism. It is reverse engineering, because we didn’t previously know those areas were susceptible.
The cardiovascular system is benefitting from the knowledge we’ve gained from new cancer treatments – the drug developments go hand-in-hand with each other and it is very exciting.
How do you work with a patient’s oncologist?
The key is really about communication – and there is probably no set way in which you support an oncologist or the patient through this whole ordeal. You have to develop a comfort level with the different providers — in some situations you are going to mostly take over and in others you are just going to be an advisor.
You have to pay attention to what people want and what way works best to improve the patient’s care. There are a lot of moving parts. The challenge is that therapies now are so rapidly changing, even when you start to feel like you have a good handle on what a particular medicine can do, there is a newer version that has come out that might even be better for your patient.
Where are you from?
I was born in Cleveland Ohio, but moved to Oak Ridge, Tennessee when I was a little boy. I grew up in East Tennessee, so I consider that my home. It is definitely an area of the country I am extremely partial to.
What is a not-to-be-missed spot in Tennessee?
There are a lot of really beautiful places in Tennessee. Of course, Nashville itself is an extremely exciting city and a great place to visit. I like being outdoors, so the Smoky Mountains are the best place in the world, in my opinion.
What particular award or achievement that is most gratifying?
When I have a patient who is suffering and has just been given a difficult diagnosis with treatment that is going to last a year or two — what is most gratifying is to see how much that patient is helped by careful treatment. It is motivating when, down the road, I see that patient in much better health and with a positive outlook. It is amazing.
You were outstanding scholar athlete at the University of Tennessee — that was a noteworthy achievement.
Yes, that is probably one of the awards I am most proud of — because I was committed to being physically active and being part of a team. But at the same time I had to go to school and make sure I got good enough grades to get into medical school. That was a big challenge.
What is the best advice you’ve received?
That is a tough question. When I was an intern, early in my training, one of my senior residents said the best way to show you are capable and intelligent and ready for whatever challenges might come your way is “To just show up and make sure you show up every time you need to be there.” That is probably the best advice I’ve gotten.
If you weren’t a doctor, what would you like to be doing?
It depends on how old I am. If I was back in college, I would probably rather be playing professional soccer, but that ship has sailed. I always enjoyed being a coach for my kids, and my mom was an English teacher, so there was a natural tendency to want to teach people. I’m sure I would have been a teacher if I wasn’t a physician.