Practical and cost-effective model to build and sustain a cardio-oncology program
Tóm tắt
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. 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. 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. 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.
Tài liệu tham khảo
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.
CDC, NCHS. Underlying Cause of Death 1999–2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999–2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed 3 Feb 2015.
Herrmann J. From trends to transformation: where cardio-oncology is to make a difference. Eur Heart J. 2019;40:3898–900.
Sturgeon KN, Deng L, Bluethman SL, et al. A population based study of cardiovascular disease mortality risk in US cancer patients. Eur Heart J. 2019;40:3889–97.
Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami”. Cancer Epidemiol Biomark Prev. 2016;25:1029–36.
Barac A, Murtagh G, Douglas P, et al. Health of Patients with Cancer and Cancer Survivors. JACC. 2015;65:2739–46.
Fradley MG, Brown AC, Shields B, et al. Developing a comprehensive cardio-oncology program at a cancer institute: the Moffitt experience. Oncol Rev. 2017;11:340.
Cheng R, Masri C, Barac A. Developing a cardio-oncology program from an early career prospective: challenges. ACC website march 28, 2018 Hayek S, Ganatra S, Barac a, Ky B et al. preparing the cardiovascular workforce to care for oncology patients. JACC. 2019;73:2226–35.
Hayek S, Ganatra S, Barac A, Ky B, et al. Preparing the cardiovascular workforce to care for oncology patients. JACC. 2019;73:2226–35.
Lenihan DJ, Hartlage G, DeCara J, et al. Cardio-oncology training: a proposal from the international Cardioncology society and Canadian cardiac oncology network for a new multidisciplinary specialty. J Card Fail. 2016;22:465–71.
Okwosa T, Prabhu N, Patel H, et al. The cardiologist and the Cancer patient. JACC. 2018;72(2):228–32.
Owuosa T, TH YE, Barac A. Burgeoning cardio oncology programs. JACC. 2015;66:1193–7.
Thavendiranathan P, Plana JC, Popovic ZB, Marwick TH. Reproducibility of echocardiographic techniques for sequential assessment of LVEF in patients undergoing chemotherapy. JACC. 2013;61:77–84.
Cardinale D, Colombo A, et al. Anthracycline induced cardiomyopathy: clinical relevance and response to pharmacological therapy. JACC. 2010;55:213–20.
Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after ancer treatment. A report from the ASE and the EACI. Eur Heart J of Cardiovasc Imaging. 2014;15:1063–93.
Zamorano JL, Lancellotti P, Rodriguez Munoz D, et al. 2016 ESC position paper on cancer treatment and cardiovascular toxicity developed underthe auspices of the ESC Committee for Practice Guidelines: The Task Force for Cancer Treatment and Cardiovascular Toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016;(37);36:2768–801.
Prevention and monitoring of Cardiac Dysfunction in Survivors of Adult Cancers. American society of Clinical Oncology Clinical Practice guideline. J Clin Onc. 2016;35:893–911.
Raj S, Franco VI. Lipshultz SE: a review of pathophysiology, diagnosis and treatment. Curr Treat Options Cardiovasc Med. 2014;16:315.
Sawyer D. Anthracyclines and heart failure. N Engl J Med. 2013;368:1154–6.
Ewer M. S, Vooletich M.T., Durand J.B., et al. Reversibility of trastuzumab related cardiotoxicity. J Clin Oncol 2005:23:7820–7826.
Cardinale D, Colombo A, Torrisi R, et al. Trastuzumab induced cardiotoxicity: clinical and prognostic implications of troponin I evaluation. J Clin Oncol. 2010;28:3910–6.
Tsai HT, Isaacs C, Fu AZ, et al. Risk of CV adverse events from trastuzumab in elderly persons with breast cancer. Breast Cancer Res Treat. 2014;144:163–70.
Li W, Croce K, Steensma DP, McDermott DF, Ben Yehuda O, Moslehi J. Vascular and metabolic implications of novel targeted cancer therapies: focus on kinase inhibitors. J Am Coll Cardiol. 2015;66:1160–78.
Cornell F, Ky B, Weiss B, et al. Prospective study of cardiac events during proteasome inhibitgor therapy for relapsed multiple myeloma. J ClinOnc. 2019;37(22):1946–55.
Patel VG, Cornell RF. Cardiovascular complications associated with multiple myeloma therapies. Current Oncol Rep. 2019;21(4):29.
Cole DC, Frishman WH. Cardiovascular complications of proteasome inhibitors. Cardiol Rev. 2018;26(3):122–9.
Sorrentino MF, Kim J, Foderaro AE, Truesdell AG. 5-fluoruracil induced cardiotoxicity: Review of the literature. Cardiologyjournal. 2012;19(5):453–8.
Mahmood S, Fradley MG, Neilan T, et al. Myocarditis in patients treated with immune check point inhibitors. J Am Coll Cardiol. 2018;71(16):1755–64.
Salem JE, Manoucheri A, Moey M, et al. Cardiovascular toxicities associated with immune check point inhibitors: an observational, retrospective, pharmacovigilance study. Lancet Oncol. 2018;19:1579–89.
Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368:987–98.
Donnellan E, Phelan D, McCarthy C, Collier P, Desai M, Griffin B. Radiation induced heart disease: a practical guide to diagnosis and management. Clev Clin J Med. 83(12):914–22.
Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol. 2014;63:2751–68.
Sulpher J, Mathur S, Dent S, et al. Clinical experience of patients referred to a multidisciplinary cardio-oncology clinic. An obsservational study. J Oncology. 2015;2015:5.
Barros-Gomes S, Herrmann J, Mulvagh SL, Lerman A, Lin G, Villarraga HR. Rationale for setting up a cardio-oncology unit: our experience at Mayo Clinic. Cardio-Oncology. 2016;2:5.
Sundlöf DW, Patel BD, Schadler KC, Biggs RG, Fadlon CA, Corotto PS, Tolay S, Nadeem AJ, Gupta R, Ahmad NV. Development of a cardio-oncology program in a community hospital JACC. CardioOncology. 2019;1(2):310–3.
Gulati G, Heck SL, Ree AH, et al. Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2 x 2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol. Eur Heart J. 2016;37:1671–80. https://doi.org/10.1093/eurheartj/ehw022.
Pituskin E, Mackey J, Koshman S, Jassal D, et al. MANTICORE 101-breast: a randomized trial for the prevention of trastuzumab associated cardio-toxicity. J Clin Oncol. 2016;35:870–7.
Samuel Avila M. Moreira Ayub Ferreira S, et al. Carvedilol for chemotherapy related cardiotoxicity. The CECCI trial. J Amer Coll Cardiol. 2018;71(20):2281–90.
Guglin M, Kirscher J, Tamura R, et al. Randomized trial of lisinopril versus carvedilol to prevent trastuzumab cardiotoxicity inpatients with breast cancer. J Amer Coll Cardiol. 2019;73(22):2859–68.
Smith A, Thomas E, Snoswell C et al. Telehealth for global emergencies. Implications for COVID 19. Sage J. 2020. https://doi.org/10.1177/1357633X20916567.
Ohannessian R, Duong TA, Odone A. Global telemedicine implementation and integration within health systmes to fight the COVID 19 pandemic: a call to action. JMIR. 2020;6(2).