Practical and cost-effective model to build and sustain a cardio-oncology program

Abstract

Background: Cardio-Oncology (CO) is a new subspecialty that thrives mostly in large academic quaternary centers. This study describes how to establish a successful cardio-oncology program, with limited resources, in order to effectively manage the unique care required by this patient population. Methods: Clinical data was collected from 25 consecutive months. There were four foundational elements to establish a CO program: 1. Clinical program: integrating staff and resources from the Heart and Vascular, and Cancer Centers; 2. Education Program: establishing a platform to educate/advocate with respect to CO; 3. Engagement with professional societies: active engagement allowed for the successful establishment of the proposed CO program; and 4. Research program: establishing data collection modalities/cooperation with other institutions. Results: 474 consecutive patients were treated by our CO program during the first 25 months of operation. Clinical data, information about cancer treatment, cardiovascular co morbidities, cardiac testing and impact of CO management are reported. Conclusions: A successful CO program can be established utilizing existing resources without the need for significant additional assets. Integration with professional societies, advocacy, education and research, provide a platform for learning and growth. This model improves access to care and can be reproduced in a variety of settings.

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

“…We see a variety of cancer patients, types, and drugs (Fig. 5 ), and our distribution results are generally congruent with reports from other leading cardio-oncology clinics [ 8 , 14 , 15 , 17 , 22 ].…”

“…Individuals with breast, lung, and hematologic cancers represent a substantial proportion of our patient population, similar to other Cardio-Oncology clinics [ 8 , 14 , 22 , 26 ]. The most frequent cancer diagnosis, breast cancer (43%), is consistent with reports from other leading cardio-oncology clinics such as the Mayo Clinic (39.2%) [ 15 ] and the Cleveland Clinic in Florida (44.3%) [ 14 ]. While hematologic malignancies such as leukemia and lymphoma represented 29% of our patients and was the second most prevalent cancer within our cohort, they comprised the most frequent forms of cancer at other cardio-oncology clinics such as at the Moffitt Cancer Center (31%) [ 8 ] and at UCLA (32.70%) [ 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. 5 b) [ 8 , 14 ]. Accordingly, at some other leading centers, the most frequent cardiovascular diagnosis or indication for referral has been reported as hypertension [ 14 ], arrythmia [ 17 ], or comprehensive risk assessment prior to beginning of therapy to optimize cardioprotection [ 8 ] in the practice of Preventive Cardio-Oncology [ 21 ].…”

“…5 b) [ 8 , 14 ]. Accordingly, at some other leading centers, the most frequent cardiovascular diagnosis or indication for referral has been reported as hypertension [ 14 ], arrythmia [ 17 ], or comprehensive risk assessment prior to beginning of therapy to optimize cardioprotection [ 8 ] in the practice of Preventive Cardio-Oncology [ 21 ]. This illustrates an opportunity for growth in our Clinic, to increase the fraction of high-risk patients who undergo comprehensive cardiovascular risk evaluation and management of risk factors prior to administration of cardiotoxic therapy.…”

“…Yet, anthracyclines were typically noted more commonly than trastuzumab. The Cleveland Clinic in Florida saw patients most commonly treated with radiation (40%), followed by anthracyclines (26.8%) [ 14 ]. The Moffitt Cancer Center most frequently had patients who were treated with anthracyclines (52%), with HER2 targeted therapies representing 27% of the cancer drugs [ 8 ].…”