Developing a comprehensive Cardio-Oncology Program at a Cancer Institute: the Moffitt Cancer Center experience

Fradley, Michael G.; Brown, Allen C.; Shields, Bernadette; Viganego, Federico; Damrongwatanasuk, Rongras; Patel, Aarti; Hartlage, Gregory; Roper, Natalee; Jaunese, Julie; Roy, Larry; Ismail‐Khan, Roohi

doi:10.4081/oncol.2017.340

Cited by 39 publications

(40 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although HaH programs require lead time for start‐up and working through policy and payment issues, many organizations have access to or can build the services they need. This is similar to developing service lines in other areas . Recent reports in the media and through personal contact with the HaH‐Plus team demonstrate that health systems are increasingly implementing HaH programs and entering into risk contracts with insurers.…”

Section: Discussionmentioning

confidence: 74%

Starting Up a Hospital at Home Program: Facilitators and Barriers to Implementation

Brody

Arbaje

DeCherrie

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

Background Hospital at home (HaH) is a model of care that provides acute‐level services in the home. HaH has been shown to improve quality and patient satisfaction, and reduce iatrogenesis and costs. Uptake of HaH in the United States has been limited, and little research exists on how to implement it successfully. Objectives This study examined facilitators and barriers to implementation of an HaH program. Design A HaH program that included a 30‐day transitional care bundle following the acute stay was implemented through a Centers for Medicare & Medicaid Services Innovations Award. Informants completed a priming table describing initial implementation components, their barriers, and facilitators. These were followed up with semistructured focus groups and individual interviews that were transcribed and independently coded using thematic analysis by two independent investigators. Setting Large urban academic health system. Participants Clinical and administrative personnel from Mount Sinai, the Visiting Nurse Service of New York, and executive leaders at partner organizations (laboratory, pharmacy, radiology, and transportation). Results To facilitate successful development and implementation of a high‐quality HaH program, a number of barriers needed to be overcome through significant teamwork and communication internally with policymakers and external partners. Areas of paramount importance include facilitating work‐arounds to regulatory barriers and health system policies; altering an electronic health record that was not designed for HaH; developing the necessary payment and billing mechanisms; and building effective and collaborative partnerships and communication with outside vendors. Conclusion Development of HaH programs in the United States are feasible but require strategic planning and development of strong, tightly coordinated partnerships. J Am Geriatr Soc 67:588–595, 2019.

show abstract

Section: Discussionmentioning

confidence: 74%

Starting Up a Hospital at Home Program: Facilitators and Barriers to Implementation

Brody

Arbaje

DeCherrie

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…This results in limited data to guide oncologists when they treat comorbid patients in the real-world and contributes to variations in management whereby physicians based their decisions on anecdotal experience. It is likely in these scenarios that physicians resort to the use of patient-related factors such as age and performance status, as well as the expertise of cardio-oncologists in formulating their treatment plans (32,33). Broadening of eligibility criteria in clinical trials to represent patients with a history of cardiovascular disease will increase the generalizability of results to real-world patients and optimize evidence-based treatment in this subpopulation.…”

Section: Discussionmentioning

confidence: 99%

Impact of Pre-Existing Cardiovascular Disease on Treatment Patterns and Survival Outcomes in Patients With Lung Cancer

Batra¹,

Sheka

Kong

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Baseline cardiovascular disease can impact the patterns of treatment and hence the outcomes of patients with lung cancer. This study aimed to characterize treatment trends and survival outcomes of patients with pre-existing cardiovascular disease prior to their diagnosis of lung cancer.Methods: We conducted a retrospective, population-based cohort study of patients with lung cancer diagnosed from 2004 to 2015in a large Canadian province. Multivariable logistic regression and Cox regression models were constructed to determine the associations between cardiovascular disease and treatment patterns, and its impact on overall and cancer-specific survival, respectively.Results: A total of 20,689 patients with lung cancer were eligible for the current analysis. Men comprised 55%, and the median age at diagnosis was 70 years. One-third had at least one cardiovascular disease, with the most common being congestive heart failure in 15% of patients. Pre-existing cardiovascular disease was associated with a lower likelihood of receiving chemotherapy (odds ratio [OR],0.53;95% confidence interval [CI],0.48-0.58;P < .0001), radiotherapy (OR,0.76;95% CI,0.7-0.82;P < .0001), and surgery (OR, 056; 95% CI,0.44-0.7;P < .0001). Adjusting for measured confounders, the presence of pre-existing cardiovascular disease predicted for inferior OS (hazard ratio [HR], 1.1; 95% CI, 1.1-1.2; P < .0001) and CSS (HR,1.1; 95% CI, 1.1-1.1; P < .0001). Conclusions: Patients with lung cancer and pre-existing cardiovascular disease are less likely to receive any modality of cancer treatment and have poor OS and CSS. As effective therapies such as immuno-oncology drugs are introduced, early cardio-oncology consultation may optimize management and outcomes of lung cancer.

show abstract

“…A survey conducted by the American College of Cardiology (ACC) distributed to centers with cardiology programs found that only 27% of centers had dedicated cardio-oncology programs. 24 An observational study of a multidisciplinary clinic demonstrated that despite 55% of patients experiencing a decrease of EF by at least 10%, 81% of the patients were able to complete greater than 90% of trastuzumab therapy. 25 A similar study of a larger patient population found that 191 of the 225 patients (85.3%) were able to complete their prescribed cancer treatments.…”

Section: Discussionmentioning

confidence: 99%

Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital

Chen

Dalsania

Hamad³

2020

Preprint

View full text Add to dashboard Cite

Background: Cardiotoxicity remains a dreaded complication for patients undergoing chemotherapy with human epidermal growth factor (HER)-2 receptor antagonists and anthracyclines. Though many studies have looked at racial disparities in heart failure patients, minimal data is present for the cardio-oncology population. Methods: We queried the echocardiogram database at a safety net hospital, defined by a high proportion of patients with Medicaid or no insurance, for patients who received HER2 receptor antagonists and/or anthracyclines from January 2016 to December 2018. Patient demographics, clinical characteristics, and treatment outcomes were collected. Based on US census data in 2019, home ZIP codes were used to group patients into quartiles based on median annual household income. The primary end point studied was referral rate to cardiology for patients undergoing chemotherapy. Results: We identified 149 patients who had echocardiograms and also underwent treatment with HER2 receptor antagonists and/or anthracyclines, of which 70 (47.0%) were referred to the cardio-oncology program at our institution. Basic demographics were similar, but white patients were more likely to live in ZIP codes with higher income quartiles (p<0.00001). Comparing between racial groups, there was no statistical difference in the percentage of patients that had a reduction in ejection fraction (EF) (p=0.75). There was no statistical difference between racial groups in the number of cardiology or oncology appointments attended, number of appointments cancelled, average number of echocardiograms received, additional cardiac imaging received. Black patients were more likely to receive ACEI/ARB post chemotherapy (p=0.047). A logistic regression model was created using race, age, gender, insurance, income quartile by home ZIP code, comorbidities (hypertension, hyperlipidemia, coronary artery disease, arrhythmia, diabetes mellitus, smoking, family history, age >65), procedures (coronary stents, cardiac surgery), medications pre-chemotherapy, cancer type, cancer stage, and chemotherapy. This model found that there was an increased referral rate among patients from higher income quartiles (p=0.017 for quartile 3, p=0.049 for quartile 4), patients with a history of hypertension (p<0.0001), and patients with breast cancer (p=0.02). Conclusions: The results of this study suggest that patients of our cardio-oncology population at a safety net hospital receive the same level of surveillance and treatment, and develop drop in ejection fraction at similar rates regardless of their race. However, patients that reside in ZIP codes associated with higher income quartiles, with hypertension, and with breast cancer, are associated with increased rate of referral.

show abstract

Developing a comprehensive Cardio-Oncology Program at a Cancer Institute: the Moffitt Cancer Center experience

Cited by 39 publications

References 59 publications

Starting Up a Hospital at Home Program: Facilitators and Barriers to Implementation

Starting Up a Hospital at Home Program: Facilitators and Barriers to Implementation

Impact of Pre-Existing Cardiovascular Disease on Treatment Patterns and Survival Outcomes in Patients With Lung Cancer

Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital

Contact Info

Product

Resources

About