Clinical Experience of Patients Referred to a Multidisciplinary Cardio-Oncology Clinic: An Observational Cohort Study

Kappel, Coralea; Rushton, Moira; Johnson, Christopher; Aseyev, Olexiy; Small, Gary; Law, Angeline; Ivars, Josee; Dent, Susan

doi:10.3747/co.26.4509

Cited by 26 publications

(27 citation statements)

References 16 publications

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“…Our most frequent cardiovascular diagnosis was cardiomyopathy (34%), which is reflective of the management need that first helped start the emerging field of Cardio-Oncology, and is similar to the most frequent cardiovascular diagnosis noted by clinicians from several other leading centers (20-35%) [24,25]. However, Cardio-Oncology has grown remarkably over the last 10-20 years, with a wide spectrum of cardiovascular diagnoses and indications for referral ( Fig.…”

Section: Discussionsupporting

confidence: 57%

A virtual-hybrid approach to launching a cardio-oncology clinic during a pandemic

et al. 2021

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Background As cardiovascular disease is a leading cause of death in cancer survivors, the new subspecialty of Cardio-Oncology has emerged to address prevention, monitoring, and management of cardiovascular toxicities to cancer therapies. During the coronavirus disease of 2019 (COVID-19) pandemic, we developed a Virtual-Hybrid Approach to build a de novo Cardio-Oncology Clinic. Methods We conceptualized a Virtual-Hybrid Approach including three arms: information seeking in locations with existing Cardio-Oncology clinics, information gathering at the location for a new clinic, and information sharing to report clinic-building outcomes. A retrospective review of outcomes included collection and synthesis of data from our first 3 months (at pandemic peak) on types of appointments, cancers, drugs, and cardiotoxicities. Data were presented using descriptive statistics. Results A de-novo Cardio-Oncology clinic was developed structured from the ground up to integrate virtual and in-person care in a hybrid and innovative model, using the three arms of the Virtual-Hybrid Approach. First, we garnered in-person and virtual preparation through hands-on experiences, training, and discussions in existing Cardio-Oncology Clinics and conferences. Next, we gleaned information through virtual inquiry and niche-building. With partners throughout the institution, a virtual referral process was established for outpatient referrals and inpatient e-consult referrals to actualize a hybrid care spectrum for our patients administered by a multidisciplinary hybrid care team of clinicians, ancillary support staff, and clinical pharmacists. Among the multi-subspecialty clinic sessions, approximately 50% were in Cardio-Oncology, 20% in Preventive Cardiology, and 30% in General Cardiology. In the hybrid model, the Heart & Vascular Center had started to re-open, allowing for 65% of our visits to be in person. In additional analyses, the most frequent cardiovascular diagnosis was cardiomyopathy (34%), the most common cancer drug leading to referral was trastuzumab (29%), and the most prevalent cancer type was breast cancer (42%). Conclusion This Virtual-Hybrid Approach and retrospective review provides guidance and information regarding initiating a brand-new Cardio-Oncology Clinic during the pandemic for cancer patients/survivors. This report also furnishes virtual resources for patients, virtual tools for oncologists, cardiologists, and administrators tasked with starting new clinics during the pandemic, and innovative future directions for this digital pandemic to post-pandemic era.

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Section: Discussionsupporting

confidence: 57%

A virtual-hybrid approach to launching a cardio-oncology clinic during a pandemic

et al. 2021

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“…However, it is reasonable to support their use as these agents have demonstrated cardio-protective properties. Also, they are generally safe and already in use in several cardio-oncology clinics [39,53,54].…”

Section: Ctn In Preventive and Guided Therapiesmentioning

confidence: 99%

Cardiac Biomarkers in Patients with Cancer: Considerations, Clinical Implications, and Future Avenues

et al. 2020

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Purpose of the Review As the number of cancer survivors increases due to early screening and modern (antineoplastic) treatments, cancer treatment associated cardiotoxicity (CTAC) is becoming an increasing health burden that affects survival and quality of life among cancer survivors. Thus, clinicians need to identify adverse events early, in an effort to take suitable measures before the occurrence of permanent or irreversible cardiac dysfunction. Recent Findings Cardiac troponin (cTn) and B-type natriuretic peptide (BNP) have been proven to detect subclinical cardiotoxicity during antineoplastic treatment. As such, these cardio-specific biomarkers could predict which patients are at risk of developing CTAC even before the start of therapy. Nevertheless, there are inconsistent data from published studies, and the recommendations regarding the use of these biomarkers and their validity are mostly based on expert consensus opinion. Summary In this review, we summarize available literature that evaluates biomarkers of CTAC, and we encourage strategies that integrate circulating biomarkers and cardiac imaging in identifying cancer patients that are at high risk.

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“…The European Society of Cardiology (ESC) published a report that outlines the different ways a cardiooncology service could be structured depending on local circumstances [11]. This recommends that a cardiooncology service is based on close multidisciplinary team (MDT) collaboration [25,26]. At the core is at least one cardiologist with an interest in cardiac problems in cancer patients, as well as cancer specialists, including oncologists, haematologists and radiologists.…”

Section: Components Of a Modern Cardio-oncology Servicementioning

confidence: 99%

What Does a Cardio-oncology Service Offer to the Oncologist and the Haematologist?

2021

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Cardio-oncology is an emerging subspecialty arising from the need for multidisciplinary collaboration to address the increasing prominence of cardiovascular disease (CVD) among cancer patients. This overview outlines the case for establishing cardio-oncology services and defines the ways in which these services benefit cancer patients. The primary objective of cardio-oncology is to manage CVDs in order to allow cancer patients to complete the best cancer treatments safely and with minimal interruption. In the decades since the first discovery of heart failure induced by anthracycline chemotherapy, both cardiovascular and oncological science have advanced considerably. Cardio-oncology services aim to bring together expertise from these two fast moving fields in order to provide optimal evidence-based care for cancer patients with CVDs. Here we discuss the basis of cardio-oncology services by presenting their rationale and key components, as well as their essential roles in education, training and research. At each stage of the cancer care pathway, a cardio-oncology service can add value by ensuring cancer patients have timely access to specialist care backed up by cutting edge diagnostic tools and treatment options, as well as holistic supports. We highlight areas of recent and upcoming developments in the field that are likely to change established clinical practice. Improved cardiac imaging modalities can detect chemotherapy-related cardiac dysfunction earlier and are also essential for the prompt diagnosis of an expanding range of cardiovascular effects complicating newer cancer therapeutics, such as immune checkpoint inhibitors and other targeted therapies. Modern cancer therapy has dramatically improved cancer survival and as such CVD is becoming one of the principal determinants of overall outcome for cancer patients. A dedicated cardio-oncology service can facilitate the optimisation of cardiovascular treatment and enable the completion of cancer therapy. A multidisciplinary collaborative approach is key to achieving these objectives.

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Clinical Experience of Patients Referred to a Multidisciplinary Cardio-Oncology Clinic: An Observational Cohort Study

Cited by 26 publications

References 16 publications

A virtual-hybrid approach to launching a cardio-oncology clinic during a pandemic

A virtual-hybrid approach to launching a cardio-oncology clinic during a pandemic

Cardiac Biomarkers in Patients with Cancer: Considerations, Clinical Implications, and Future Avenues

What Does a Cardio-oncology Service Offer to the Oncologist and the Haematologist?

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