Cancer Through My Eyes – Episode 12: Tanesh Ayyalu

In this episode of Cancer Through My Eyes, we meet a physician who has found meaning in the space where cancer care and cardiovascular medicine intersect. With a path defined by service, adaptability, and a commitment to lifelong learning, Dr. Tanesh Ayyalu’s story is one of intentional discovery — led by curiosity and grounded in purpose.

Dr. Ayyalu is a Cardio-Oncology Fellow at MedStar Georgetown University Hospital, following an Advanced Cardiac Imaging Fellowship at Lenox Hill Hospital. After completing Internal Medicine residency during the height of the COVID-19 pandemic, his journey has been shaped by a desire to merge his interests in oncology and cardiology to support and empower cancer patients at risk for cardiac complications.

Dr. Tanesh Ayyalu’s Story

Raised across different parts of the United States before returning to his roots to complete his M.B.B.S. at Amrita Institute of Medical Sciences in India, Dr. Ayyalu brings a global lens to his work. His early experiences volunteering in mobile primary care clinics in North Texas, and as a cardiovascular outcomes research associate laid the foundation for a career centered on access, equity, and translational impact.

Though originally drawn to oncology out of medical school, he began exploring cardiology after meeting engaging mentors during residency at LIJ Forest Hills Hospital. After developing advanced imaging skills and seeing the nuanced cardiac needs of cancer patients, Dr. Ayyalu found his calling in cardio-oncology. He now stands at the forefront of an emerging field—bridging disciplines, advocating for survivors, and pushing forward the integration of cardiovascular care into the cancer continuum.

                                      Q&A with Dr. Ayyalu

1. What first inspired you to combine cardiology and oncology, and how did that passion turn into pursuing a fellowship in Cardio-Oncology?

I always wanted to find a niche in medicine that was both personally and intellectually rewarding. I believe finding the right fit is one of the hardest things for any trainee—it’s often oversimplified or not discussed enough, even though it ultimately shapes your patient population, schedule, administrative burden, and long-term fulfillment. For me, it took a lot of introspection. I didn’t enter internal medicine training with a solid idea that I would go into cardio-oncology. Coming out of medical school, I was excited about oncology and worked with many underserved and uninsured cancer patients at a mobile clinic in Dallas, which was incredibly rewarding. That passion took a backseat during my internal medicine training, which began during the early waves of COVID in New York. Midway through residency, a mix of personal experiences with heart disease in my family, the luck of meeting stellar mentors, and exposure to clinical research shifted my focus toward cardiology. However, I never lost the desire to work with oncology patients. After residency, I had the opportunity to train in advanced cardiac imaging and became proficient in multimodality imaging, which is something many oncology patients frequently need. That’s when I began to truly understand how cardiology and oncology are intertwined, and the importance of this emerging field. While applying for a general cardiology fellowship, I used my gap year to deepen my knowledge and exposure by pursuing a cardio-oncology fellowship. It allowed me to fuse both my interests and be part of a growing specialty with exciting potential for research and impact. I feel that my training trajectory has been unique and has given me a chance to engage with multiple subspecialties and deeply rewarding patient populations.

2. Chemotherapy and radiation can have significant cardiac side effects. Has this awareness influenced your approach to care?

I think of chemotherapy and radiation as a classic double-edged sword. In the quest to eradicate cancerous cells, they can inadvertently affect everything from nerves and neurons to vessels and cardiac myocytes, both in the short and long term. The timing of when we see a patient during their cancer journey and their symptoms plays a big role in how we assess risk, screening needs, and counseling. Not all chemotherapy carries equal cardiac risk. Anthracycline-containing regimens are the highest risk, especially in older patients with pre-existing conditions like hypertension, diabetes, obesity, or heart failure. This risk can be potentiated by agents such as 5-fluorouracil, cyclophosphamide, gemcitabine, or taxanes. While we have data on common side effects, each patient’s unique timeline, treatment combination, and accompanying symptoms (like fatigue or deconditioning) often make a tidy diagnosis difficult. My experience so far has taught me the importance of listening closely and never dismissing symptoms.

With radiation therapy, I pay close attention to the type (external, internal, or proton, to name a few), the dose, timing, and target field. For example, patients receiving mediastinal or left chest radiation are at higher risk for pericarditis, effusions, or accelerated plaque deposition. Those treated with head and neck radiation may experience earlier plaque in their carotids or damage to baroreceptors, which can lead to lasting positional blood pressure changes. In survivors who are in remission or have completed curative therapies, the focus shifts to aggressive cardiovascular risk reduction, since heart disease often becomes their primary mortality risk. This includes lifestyle changes, early screening, and managing comorbidities like hypertension, dyslipidemia, and diabetes—conditions that may be more prevalent after chemoradiation. Thankfully, many of the more common cardiac side effects seen in the past are now rarer due to lower anthracycline doses and more targeted/ sparing radiation.

3. Balancing cancer treatment efficacy with preserving cardiovascular health can be complex. How do you collaborate with oncologists to find the right harmony between saving lives and protecting the heart?

Collaboration is the cornerstone of cardio-oncology, and the field cannot exist without close communication, mutual learning, and respect between cardiologists and oncologists. In this fellowship, I’ve had the opportunity to see patients alongside oncologists to better understand their overall cancer care, participate in multidisciplinary discussions, and participate in survivorship clinics to appreciate what patients experience long after treatment ends. It’s crucial to understand your specific role as a cardio-oncologist—where your expertise ends, and where your input can make a meaningful difference. Even something as straightforward as starting a statin can have broader implications due to drug interactions or impacts on clinical trial eligibility. My approach always starts with understanding the reason for referral, counseling the patient clearly, and establishing a two-way communication channel with the treating oncologist. Since oncology plans can evolve rapidly due to side effects, progression, or new data, the cardiac impact may also shift. Cardio-oncologists aim to stay informed and adaptable to minimize treatment interruptions. There is growing evidence around “permissive cardiotoxicity” where temporary reductions in cardiac function are monitored closely but tolerated. “Reverse cardio-oncology” is also an emerging concept, pointing to the bidirectional relationships between cancer and cardiovascular disease. I believe better interdisciplinary communication and awareness will continue to drive improved outcomes and exciting discoveries.

4. As a Cardio-Oncology Fellow, you see firsthand how cardiac complications impact survivorship. What are some of the key lifestyle or medical interventions you recommend to enhance both heart and overall cancer outcomes?

Cancer survivorship is often an overlooked phase of cancer care. Patients go from frequent, intensive oncology visits, where they feel understood and closely monitored, to general follow-up, which can feel disjointed and unfamiliar. Many are unaware of what late complications to watch for, and some primary care providers may not be fully equipped to counsel survivors on their specific risks. This can leave patients feeling overwhelmed at having to advocate for themselves or abandoned. Survivorship care plans that summarize treatment history in accessible language can help bridge this gap. If I had to emphasize one intervention, it would be exercise. Across all stages of cancer treatment and cardiovascular care, physical activity improves outcomes, and movement is medicine. It reduces weight, enhances vascular compliance, and combats the fatigue and deconditioning that follow chemotherapy. While guidelines recommend 150 minutes of moderate-intensity exercise per week, I always encourage patients to start small and build sustainable habits. Things as simple as brisk walking and light resistance training with bands or weights are great starting points. Diet-wise, I advise a more plant-based or Mediterranean-style diet to reduce inflammation, and inquire/push for smoking cessation if relevant.

5. Advancements in immunotherapy and targeted agents are changing the oncology landscape. From a cardio-oncology lens, which new treatments excite you the most, and which ones do you monitor most carefully for potential cardiac risks?

Immunotherapy covers a broad array of medications that include immune checkpoint inhibitors, HER2-targeted therapy, CAR-T (Chimeric Antigen Receptor T-cell therapy), and even BiTE (bispecific T-cell engager) therapy. From a cardio-oncology standpoint, we’ve been managing HER2 inhibition in breast cancer the longest. It’s generally safe, especially with newer formulations, but we monitor for systolic dysfunction with imaging every three months, regardless of risk. I’m excited about moving toward more personalized surveillance schedules, guided by better risk stratification models. Immune checkpoint inhibitors, introduced with Ipilimumab for melanoma in 2011, have transformed cancer care by improving survival across multiple cancers. These agents target inhibitory checkpoint proteins (PD-1, PD-L1, CTLA-4) that cancers exploit to avoid immune detection. However, they can provoke inflammation in any organ, including the heart, most notably as myocarditis. I’m hopeful that newer predictive tools and treatments for this complication will reduce reliance on high-dose steroids, which often disrupt cancer care. CAR-T and BiTE therapies can trigger cytokine release syndrome and cardiac arrhythmias in addition to other adverse effects. The challenge now is identifying who is most at risk and how to mitigate that risk before treatment begins.

6. When you imagine the future of oncology, what do you most look forward to changing or improving, both in terms of patient care and how we, as a society, approach cancer?

I hope to see greater public awareness about the importance of timely and appropriate cancer screening because outcomes vary drastically based on how early cancers are detected. From a cardio-oncology lens, I also hope we begin to view cancer and cardiovascular disease not as entirely separate issues, but as interconnected. They share many risk factors and require coordinated care. Some cancers—like CML—are increasingly treated as chronic diseases, yet they still elevate residual and atypical cardiac risk through both their biology and the side effects of therapy. We need to better integrate this understanding into long-term care.

7. In your view, what’s the single biggest myth or misunderstanding that cancer patients and their families have about the side effects of cancer therapy, and how do you address it?

A common misunderstanding is that if patients didn’t have any immediate side effects from treatment, they’re in the clear long term. Many survivors, especially those of childhood cancers, disengage from the healthcare system after remission because it’s a painful reminder of what they went through. However, late complications like valvular disease, accelerated atherosclerosis, diabetes, or dyslipidemia can emerge years later. I address this by tailoring screening recommendations at every visit and encouraging them to have strong relationships with primary care providers. Long-term follow-up is about empowering patients with up-to-date information and emphasizing prevention.

8. Emotional well-being is crucial for any provider in oncology. How do you personally cope with the emotional demands of helping patients navigate both a cancer diagnosis and potential complications?

Staying grounded and practicing gratitude are things that I’ve developed over time. It is important to carve out time for things that refill your emotional cup. For me, this is spending time with loved ones, meditation, and daily exercise.  We see some incredibly sick patients who often have heartbreaking stories, and we have to remain fully present and empathetic for every patient.

9. Looking ahead, what innovations or best practices do you hope will soon become standard care in cardio-oncology, ensuring fewer patients develop long-term cardiac issues after cancer treatment?

More accurate and personalized cardiac risk stratification for different cancer therapies is greatly in need because it can help deliver safer care, reduce treatment interruptions, and reduce time toxicity for patients by decreasing repetitive cardiac testing. For long-term care, I envision better information-sharing systems across healthcare networks, so a patient’s oncologic and cardiac history follows them wherever they go. Survivorship care plans should be more commonly used, and aim to be clear, accessible, and portable. This would make long-term care more seamless for both patients and providers.

10. Younger physicians and medical students frequently seek inspiration. How do you mentor or advise them so they recognize both the burdens and the deeply rewarding aspects of working in oncology?

Working in oncology or adjacent fields may not be for everyone, and the best way to find out during training is to gain as much exposure as possible. Developing a reciprocal relationship with trusted mentors is also key. My own mentors introduced me to opportunities I didn’t even know existed, and I try to do the same for students and residents who come to me with research ideas, questions, or career path advice. The oncology population is incredibly rewarding to work with, given you have the right perspective. You get to build meaningful longitudinal relationships, witness profound resilience, and deepen your emotional perspective. There are also huge opportunities for advocacy, research, and interdisciplinary teamwork. The burdens are evident since cancer outlooks differ widely based on the pathology and stage of diagnosis, but this is where emotional grounding comes into play. The cardio-oncology population specifically is extra rewarding because many of them are “model patients” who have beaten active cancer and want to learn how to live more risk-free and fulfilling lives.

As Cancer Through My Eyes reaches its twelfth episode, Dr. Ayyalu’s story reminds us that the future of oncology lies in connection—not just between doctor and patient, but across disciplines, specialties, and systems. His work highlights how listening, innovation, and integration can turn survivorship into strength and complexity into clarity.

Have a story or suggestion for a future episode? Reach out—we’re always listening.

Stay tuned for more conversations that illuminate the hearts behind the science.

                                                                                         By Semiramida Nina Markosyan, HBSc.