Intersections of Cardio-Oncology and Psychiatry

Frank Clark, MD, sat down with Mary Branch, MD, a noninvasive cardiologist and cardio-oncology specialist currently practicing in underserved western Kentucky. The discussion centered on the bidirectional relationship between mental health and cardiovascular disease, with particular relevance for our psychiatric providers.

Branch emphasized that mental health disorders and cardiovascular disease cannot be meaningfully separated in clinical practice. Untreated psychiatric conditions impaired patients' ability to adhere to medications, absorb health information, and engage in preventive behaviors.¹ She cited a study published in the Journal of the American College of Cardiology Asia documenting an association between depression and subsequent cardiovascular disease, noting that this link was particularly pronounced in women.²

Branch identified stigma as one of the primary barriers to integrated care. When cardiac workups returned normal findings, patients frequently resisted the suggestion that symptoms such as palpitations might reflect an anxiety or depressive disorder. She observed that this resistance was compounded by inadequate social support, making it difficult to redirect patients toward psychiatric evaluation. Fewer than 20% of patients with cardiovascular disease receive adequate treatment for cooccurring depressive symptoms—a gap Branch attributed partly to patients failing to recognize psychiatric manifestations and partly to the persistent stigma surrounding mental health diagnoses.

Branch also addressed the compounding psychological burden in cardio-oncology. She noted that patients managing both a cancer diagnosis and cardiac risk faced an especially heavy load: "if you don't have a lot of support, it's just a lot to be able to manage, 1, with cancer and then, 2, with heart disease on top of that or the risk of heart disease. You can possibly beat one thing but may be in trouble for another."

On interdisciplinary collaboration, Branch advocated for formal referral networks and joint educational events between cardiology and psychiatry. She described a practical gap she encountered in her own practice: "when I was seeing a lot of young patients who had palpitations and things like that, and I tried to convince them that it wasn't heart disease, but I could definitely sense that there was an anxiety component. It would be nice to say, 'I would love for you to see my colleague, who may be able to, on the psychiatry side, just have a chat and see if this is something that could help.'"

Dr Clark is an outpatient psychiatrist at Prisma Health-Upstate and clinical associate professor at the University of South Carolina School of Medicine, Greenville. He served on the American Psychiatric Association’s Task Force to Address Structural Racism Throughout Psychiatry, and he currently serves as the Diversity and Inclusion section editor and advisory board member for Psychiatric Times.

Dr Branch is a board-certified cardiologist working in cardio-oncology and community care.

References

1. Pennells L, Mascie-Taylor CGN. Depression and incident cardiovascular disease. JACC Asia. 2024;4(4):289-291.

2. Senoo K, Kaneko H, Ueno K, et al. Sex differences in the association between depression and incident cardiovascular disease. JACC Asia. 2024;4(4):279-288.