Leading the way for cardio-oncology
Dr Singh is inspiring colleagues
YOU could say that medicine runs through Dr Trishun Singh’s veins.
As a young boy, Singh was inspired by his aunt and cousin – the late Dr Ansuyah Singh and Dr Sangamithra Urvashee Choudree respectfully – to study medicine.
Added to this were respected medical doctors and Struggle veterans of the time, who often visited his aunt.
Singh, 67, is a cardiologist and president of the newly-established Cardio-Oncology Society of Southern Africa (Cososa).
Singh was born and raised in Durban. He attended St Anthony’s Primary School, Sastri College and later the University of Witwatersrand and Natal medical schools. Today, the uMhlanga resident practices in partnership with doctors Connel Barnabas, Joe McKibbin and Aveen Mahabal at Netcare uMhlanga Hospital, St Augustine’s Hospital, Alberlito Hospital in Ballito and Margate Hospital. He and his partners are leading the path for cardio-oncology in Africa.
A cardio-oncologist is a cardiologist, who has a special understanding of cancer therapy and the effects on the cardiovascular system.
“My late aunt, Ansuyah Singh, was a well-known medical doctor, who qualified at Edinburgh University in the 1940s. She practised in Durban and was an author and playwright.
“She had a huge influence on my life, as I spent many years of my childhood with her. Her daughter, Sangamithra Urvashee Choudree, is also a medical doctor and qualified at Edinburgh University as well.
“I spent many wonderful years in my aunt’s home and was close to my cousin and still am. Urvashee is presently retired and resides in London.”
Singh said his passion for medicine was further ignited by being in the presence of veteran doctors and humanitarians, who frequented his aunt’s homes in Alfred Avenue and Reservoir Hills.
They included doctors Monty Naicker, Kesaveloo Goonum, Thegi Chetty and KM Seedat.
“My father, the late Bobby Singh, and my mother, the late Chinthamani Singh, were also role models.”
Triumphing over tragedy
In his matric year, in 1970, his father died in a car accident.
“My mother and aunt Ansuyah (who was married to Ashwin Choudree) were both widowed at the time. They pushed me to fulfil my dad’s wish to pursue a medical career. I specialised in cardiology, particularly because of the encouragement of my guru in medicine, Professor YK Seedat.
“I trained as a specialist physician in his department when he was a professor and head of medicine at Natal University. When I completed my fellowship in internal medicine, he encouraged me to pursue a further career in cardiology and arranged for my cardiology post, as a fellow in training, in that department, at Wentworth Hospital.”
Branching into cardio-oncology Singh said almost every class of cancer drugs had cardiovascular effects.
“When chemotherapy and radiotherapy are given together, either at the same time or one following the other, the potential for cardiovascular complications is great. Thus, the cardiovascular status of the cancer patient needs to be carefully evaluated before, during and after cancer treatment.
“Cancer drugs, including radiation, are effective today and many cancer patients are being cured but they are not dying from cancer, but rather from cardiovascular complications of cancer treatment.”
Singh explained that the medical fraternity started recognising this problem in the 1970s with Anthracyclines, a class of drugs used in cancer chemotherapy.
“But the field was very much in its infancy at that stage, because the only drug that was a problem, causing cardiovascular complications, was the Anthracyclines called The Red Devil.
“However, it soon became to be recognised around 2011/2012 that another drug used for breast cancer, called Trastuzumab, also had significant effects on the cardiac muscles.
“And when Trastuzumab was combined with Anthracyclines, the potential for significant involvement of heart muscle was great. Soon after that, it was recognised that almost every class of cancer drugs had deleterious effects on the cardiovascular system. Even the new drugs, like Immunotherapy, that result in fantastic cures for cancer, can have serious effects on the heart.”
Cardio-oncology centres started being established in many of the big cancer centres in the US, Canada and the UK. “However, the entire African continent had been rather slow to establish these centres.”
In fact, the first cardio-oncology centre has now been established by Singh at uMhlanga Hospital.
Trailblazing medical doctors were familiar with the field of cardio-oncology in Africa.
“My feeling is that few doctors understand cardio-oncology. This is why I am involved, trying to spread the message of the importance of cardio-oncology, so that any doctor involved with cancer care should be familiar with it.
“They need to be familiar with the effects of a cancer drug and radiation on the cardiovascular system, and, more importantly, how to identify these problems and treat them early enough to avoid irreversible cardiovascular damage.
“It is no use treating cancer and obtaining a great result when that patient is going to succumb to a cardiovascular complication. Thus, the cardio-oncologist has to work with the oncologist, treating the patient, before, during and after cancer treatment.
“Cancer societies and oncology units (public and private) need to recognise the importance of cardio-oncology.
“The government department of health involved with non-communicable diseases also needs to recognise the importance of cardio-oncology. If not, litigation can be a problem.”
Cososa is the first cardio-oncology Society in Africa and it is affiliated to Icos (International Cardio-Oncology
Society), which is the International Cardio-Oncology Society in the US.
Cosasa’s first inaugural meeting will held at the Pearls of uMhlanga on March 7. Leading medical doctors are expected to attend.
Among them, Professor Eric Harrison, the president of Icos; Dr Steven Casselli, Icos CEO; and Professor Sebastian Szmit, the head of cardio-oncology of Poland.
Locally Dr Ines Buccimazza, a breast cancer surgeon and endocrine surgeon, and Ria David, a medical oncologist, will attend. They are also on the executive of Cosasa.
Singh said their aim was to educate all doctors, radiotherapists and nurses involved with cancer care as to the role of cardio-oncology with regard to the treatment of cancer and cardiovascular complications.
“It is also important for these doctors to understand what the international guidelines and protocols are, with regard to identifying cardiovascular problems in cancer patients and following the guidelines as to how to manage these patients, how to follow-up these patients, and how to treat these patients.
“With our affiliation to Icos, this will be possible because we will have access to their protocols, guidelines and fellowship programmes.”
For details, visit www.cososa.org