Preventive Cardio-Oncology: The Time Has Come

Brown, Sherry‐Ann

doi:10.3389/fcvm.2019.00187

Cited by 38 publications

(33 citation statements)

References 178 publications

(293 reference statements)

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“…A healthy diet has been associated with a protective effect in terms of cancer relapses and cardiovascular disease, while smoking has an ominously detrimental effect. While light to moderate alcohol intake has shown a protective impact in terms of cardiovascular disease, the results in terms of risk of developing cardiotoxicity are conflicting (75)(76)(77).…”

Section: Primary Prevention: Pharmacologic Prevention (Figure 2) Lifementioning

confidence: 99%

Cardiotoxicity of Anthracyclines

Cardinale

Fabiani

Cipolla

2020

Front. Cardiovasc. Med.

293

214

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Cardiotoxicity is a feared side effect that may limit the clinical use of anthracyclines. It may indeed affect the quality of life and survival of patients with cancer, regardless of oncological prognosis. This paper provides an overview of anthracycline-induced cardiotoxicity in terms of definition, classification, incidence, risk factors, possible mechanisms, diagnosis, and treatment. We also report effective strategies for preventing cardiotoxicity. In addition, we discuss limiting current approaches, the need for a new classification, and early cardiotoxicity detection and treatment. Probably, anthracycline-induced cardiotoxicity is a continuous phenomenon that starts from myocardial cell injury; it is followed by left ventricular ejection fraction (LVEF) and, if not diagnosed and cured early, progressively leads to symptomatic heart failure. Anthracycline-induced cardiotoxicity can be detected at a preclinical phase. The role of biomarkers, in particular troponins, in identifying subclinical cardiotoxicity and its therapy with angiotensin-converting enzyme inhibitors (mainly enalapril) to prevent LVEF reduction is a recognized and effective strategy. If cardiac dysfunction has already occurred, partial or complete LVEF recovery may still be obtained in case of early detection of cardiotoxicity and prompt heart failure treatment.

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Section: Primary Prevention: Pharmacologic Prevention (Figure 2) Lifementioning

confidence: 99%

Cardiotoxicity of Anthracyclines

Cardinale

Fabiani

Cipolla

2020

Front. Cardiovasc. Med.

293

214

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“…Baseline risk assessment and follow-up start with oncology and primary care [ 21 ]. Asymptomatic low risk patients with low-risk treatment plans can have continued assessment and follow-up by oncology and primary care in partnership.…”

Section: Resultsmentioning

confidence: 99%

“…Patients who have symptoms, are at high risk based on their history, or are planned for high-risk treatment plans should be referred to Cardio-Oncology for prevention, monitoring, and management recommendations. Recommendations should adhere to society expert consensus, scientific statements, and guidelines for prevention, surveillance, and survivorship, and optimize CVD risk and medications [ 21 ]. A putative risk score based on medication-related and patient-related risk factors can be used to guide monitoring and management recommendations for most Cardio-Oncology patients [ 22 ], and can be used in a virtual clinical decision aid ( https://tinyurl.com/CardioOncCDA ) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…We offer the use of virtual risk assessment tools such as the computed risk scores based on medication- and patient-related risk factors [ 22 ] (Fig. 4 ) ( https://tinyurl.com/CardioOncCompendium ), as well as recommendations for establishing cross-provider partnerships to continuously evaluate risk [ 21 ]. Other online databases containing useful information and guidelines are readily accessible and can help guide clinical practices.…”

Section: Discussionmentioning

confidence: 99%

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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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“…Cardio-oncology is an emerging subspecialty focusing on the prevention and management of cardiovascular injury from cancer therapies [ 1 , 2 ]. It is increasingly important to consider cancer survivors’ heart health, as improved cancer survivorship has resulted in a growing number of survivors affected by cardiovascular disease [ 3 ].…”

mentioning

confidence: 99%

#CardioOncology: Twitter chat as a mechanism for increasing awareness of heart health for cancer patients

2020

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Consideration of heart health for cancer survivors is increasingly important, as improved cancer survivorship has resulted in a growing number of survivors affected by cardiovascular disease. However, there is limited knowledge of cardio-oncology among both patients and a variety of health professionals. Thus, efforts are needed to increase awareness about cardio-oncology. Social media represents one potential opportunity to disseminate information about cardio-oncology to a large audience. We highlight one example of a social media educational/advocacy campaign conducted on Twitter (a “Twitter Chat”) that garnered nearly 1.2 million impressions (views by Twitter users) in just 24 h. We provide both quantitative and qualitative data to support the efficacy of using Twitter for such educational/advocacy campaigns, and describe key features that contributed to its success. Twitter Chats inexpensively utilize innovative technology to provide education and foster community. Long-term studies are needed to understand whether Twitter Chats can change knowledge and behavior related to cardio-oncology.

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Preventive Cardio-Oncology: The Time Has Come

Cited by 38 publications

References 178 publications

Cardiotoxicity of Anthracyclines

Cardiotoxicity of Anthracyclines

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

#CardioOncology: Twitter chat as a mechanism for increasing awareness of heart health for cancer patients

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