Cardiologists, surgical oncologists deliver personalized care in tandem

Pongsiri Mungmool is celebrating this year’s holiday season with his two-year-old granddaughter, Ellie. Ellie wasn’t yet born when her grandfather received a cancer diagnosis, yet a strong partnership with care teams at Loma Linda University Health enabled Ellie to meet her grandfather and forge their inseparable bond.

Accompanied by daughters Pimsiri and Nok to help interpret from English to Thai during appointments, Pongsiri teamed up with LLU surgical oncologists and cardiologists to safeguard his heart health while beating cancer. This collaboration guided every step of his care journey, from heart and cancer surgeries to infusion therapy.

“It is essential to involve the patient and family in discussions and decision-making, as well as explain why and how we are opting to proceed in a certain direction with their care,” says Fabrizio Luca, MD, chief of the Cancer Center’s division of colon and rectal surgery and Pongsiri’s surgical oncologist.

Pimsiri says the timely, effective, and consistent nature of their communications with Luca and others helped ease the often stressful and confusing process of cancer care navigation.

“It’s the first time someone in our family has had a cancer diagnosis,” she says. “During our first visit, Dr. Luca told us the care teams would do whatever they could to help my dad. That instantly brightened up the path forward for us, and we were able to see cancer as something to be overcome.”

Optimizing a patient's health before surgery is fundamental to good outcomes, Luca says, though it is also important to consider that time is of the essence while confronting cancer.

“Surgical operation is like a race — you should be prepared and trained and, if possible, be physically fit,” Luca says. “You have to balance between that optimization and the fact that you have to treat the cancer soon.”

Because Pongsiri presented with several cardiac risk factors, including diabetes, hypertension, hyperlipidemia, and chest pain, he needed a cardiac checkup before surgery to remove his colon cancer. He became one of the first patients to join LLU’s cardio-oncology program, consulting with Vinisha Garg, MD, a cardio-oncologist at the International Heart Institute, who sees patients with overlaps of cancer diagnosis and cardiac issues.

A coronary angiogram’s results revealed Pongsiri’s severe, high-risk coronary disease, calling for a swift and carefully calculated action plan. Balancing risk factors, Garg and Luca determined the lower risk option to be a cardiac operation for Pongsiri before his cancer surgery.

“Left untreated, he likely would have had a very poor cancer surgery outcome,” says Garg.

Within three days, Pongsiri underwent an urgent coronary artery bypass graft surgery (CABG). Then, within a month, he received a minimally invasive robotic surgery for his colon cancer and proceeded with infusion therapy treatments without any delays.

“My dad is a strong guy, and he handled it well,” his daughter says about the succession of surgeries and treatment. “We could tell right away from the people at the front desk to the doctors we spoke with that the kindness and quality of the service we got here were different than elsewhere. We would not have made it this far had we not had that kind of care.”

After surgery, Pongsiri recovered and continued to work with Garg to monitor his heart health throughout cardiotoxic chemotherapy treatment by titrating medications and controlling his diabetes, cholesterol, and lipid levels.

“LLU care teams designed a course of care and treatment for Pongsiri specifically tailored to fit his needs and circumstances,” says Luca. Experts from surgical oncology, cardiology, medical oncology and the patient united to develop personalized, whole-person care that proved ultimately beneficial for him.

Touched by her father’s interactions with attentive care team members, Pimsiri recently joined LLU’s Diagnostic Cardiac Sonography program and aims to forge a career in the medical field.

“When we first learned he’d be undergoing chemotherapy, we weren’t sure we’d be able to take him along to travel around or go out to restaurants or places he wants to go,” Pimsiri says, though this did not turn out to be the case.

Every morning Pongsiri walks around his neighborhood, a significant improvement since before his procedures and treatment when he reported walking about 20 paces before feeling winded.

Now retired from owning a clothing business in Thailand, Pongsiri enjoys peaceful days in his loved ones’ company, especially Ellie’s, who Pimsiri says “has become his whole day.”

This article was originally published on the Loma Linda University Health news site.