Clinical experience of patients referred to a multidisciplinary cardio-oncology clinic: an observational cohort study

Abstract

Introduction: Cardiovascular disease is the 2nd leading cause of long-term morbidity and mortality in cancer survivors. Cardio-oncology clinics (cocs) have emerged to address the issue; however, there is a paucity of data about the demographics and clinical outcomes of patients seen in the coc setting.

Methods: Cancer patients referred to The Ottawa Hospital coc were included in this retrospective observational study. Data collected were patient demographics, cancer type and stage, reason for referral, cardiac risk factors, cardiac assessments and treatment, and clinical outcomes.

Results: Between 2008 and 2015, 779 patients (516 women, 66%; 263 men, 34%) were referred to the coc. Median age of the patients at cancer diagnosis was 60 years (range: 18-90 years). The most frequent reasons for referral were decreased left ventricular ejection fraction (33%), pre-chemotherapy assessment (14%), and arrhythmia (14%). Treatment with cardiac medication was given in 322 patients (41%), 181 (56%) of whom received more than 2 cardiac medications, with 57 (18%) receiving an angiotensin-converting enzyme inhibitor (acei), 46 (14%) receiving an acei and a beta-blocker, and 38 (12%) receiving a beta-blocker. Of 163 breast cancer patients, 129 (79%) were able to complete targeted therapy with coc co-management. Most of the 779 patients (n = 643, 83%) were alive at the time of the last data collection.

Conclusions: This cohort study is one of the largest to report characteristics and clinical outcomes of patients referred to a coc. Collaboration between oncologists and cardiologists resulted in completion of cancer therapy in most patients. Ongoing analysis of referral patterns, management plans, and patient outcomes will help to guide the cardiac care of oncology patients, ultimately optimizing cancer and cardiac outcomes alike.

Keywords: Cardio-oncology; cardiac outcomes; cardiotoxicity; lvef; targeted therapy.

FIGURE 1

Reason for referral of patients to the cardio-oncology clinic based on their cancer type and expressed as a percentage of the total number of patients within their cancer type group. GI = gastrointestinal; GU = genitourinary; CAD = coronary artery disease; HTN = hypertension; CHF = congestive heart failure; LVEF = left ventricular ejection fraction.

FIGURE 2

Cardiovascular and cancer outcomes for patients with either a breast or a gastrointestinal (GI) or genitourinary (GU) cancer and either mild or moderate (Mod) or severe (Sev) left ventricular dysfunction. RX = treatment; CV = cardiovascular; Ca = cancer.

FIGURE 3

Maximum decrease in left ventricular ejection fraction (LVEF) since initial echocardiography in patients referred to the cardiooncology clinic.