Joining Forces: Establishing a Cardio-oncology Clinic

Abstract

Patients have been surviving cancer diagnoses at a steadily increasing rate over the past few decades. Despite the encouraging decline in cancer morbidity, the cardiovascular effect of some chemotherapy medications is concerning. Moreover, even though there is extensive knowledge of the pathophysiology and increased risk of cardiotoxicity, there is a lack of specific guidelines and adequate cardio-oncology programs focused on reducing cardiovascular risks or disease in patients undergoing cancer treatment. The high incidence of both cardiovascular disease (CVD) and cancer warrants the collaboration of oncology and cardiology providers to screen and promptly treat CVD, and thereby provide an opportunity to improve cancer patients' quality of life both during treatment and extended through cancer survivorship. We found no designated cardio-oncology programs in our geographic area from Poughkeepsie to New York City; therefore, a feasibility project was developed in collaboration with a cardiologist and a cardiology nurse practitioner specializing in oncology at our institution. The project included the development and implementation of a cardio-oncology program in a suburban community cardiology practice in order to provide service in this area to breast cancer patients at risk for cardiotoxicity. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was employed to guide the project and enhance the translation of research into practice through planning and execution.

Figure 1

Percentage of responders according to the time elapsed from anthracycline administration and start of heart failure therapy. Permission granted from Daniela Cardinale, European Institute of Oncology, 12/2015.

Figure 2

Cardiovascular monitoring of cancer patients. Adapted from Albini et al. (2010). Approval for use from Adriana, Albini; permission from Oxford University Press. a Substantial changes in cardiovascular risk assessment; for example, a reduction in left ventricular ejection fraction (LVEF) from baseline greater than 5% to less than 55% with accompanying signs or symptoms of HF or a reduction in LVEF greater than 10% to less than 55%, without accompanying signs or symptoms.

Table 1

Examples of Application of RE-AIM Steps in Cardio-Oncology^a

Figure 3

Cardio-oncology care team model demonstrating the interactive process between cardiooncologists, oncologists, patients, health-care administrators, and education required for integrated patient care. Permission granted for use by Dr. Okwuosa (Okwuosa & Barac [2015]).