Cardio-oncology services may improve patient care if more widely available

Many hospital training programs lack formal training or services in cardio-oncology.
Many hospital training programs lack formal training or services in cardio-oncology.

The impact of cancer treatments on cardiovascular health is an important consideration when treating oncology patients, but many hospital training programs have no formal training or services in cardio-oncology and a lack of national guidelines and funding are frequent barriers to establishing such programs, according to results of a nationwide survey published in the Journal of the American College of Cardiology (2015; doi:10.1016/j.jacc.2015.04.059).

The American College of Cardiology (ACC) conducted the survey to determine the existing practices and current needs in this area and plan for a cardio-oncology section that would fill gaps in resources and allow specialists to share best practices, develop educational tools and practice standards, design training programs, and advocate for the specialty.

Cardio-oncology as a field includes both cardiology and oncology specialists working together across all aspects of cardiovascular risk determination, prevention, and treatment starting at cancer diagnosis and continuing throughout survivorship. Many cancers and heart disease are linked through common risk factors and prevalence in the same age population.

Also, cancer treatments can lead to cardiovascular health problems, including increased risk of cardiac dysfunction, heart failure, arrhythmias, valvular heart disease, accelerated atherosclerosis, and pericardial disease.

The ACC Early Career Section conducted a survey in May 2014 of cardiology division chiefs and cardiovascular fellowship program training directors to evaluate the current state of cardio-oncology services, practices, and opinions. Of the 106 respondents, over 70% felt that the cardiovascular implications of cancer treatments were a very important consideration in the cancer treatment continuum, and 65% thought access to consultants with specialized training would provide an advantage in caring for patients with cancer suffering cardiovascular complications.

However, only 35% of centers surveyed included cardio-oncology services in their pre-operative consultation services managed by general cardiology, and only 27% of centers had an established, specialized cardio-oncology service with multiple clinicians. Sixteen percent had a single cardiologist with expertise in treating patients with cancer, and 12% had no cardio-oncology services but planned to add them within a year.

Almost half of respondents said their programs offered no formal training in cardio-oncology, with the majority of the other half offering exposure during regular rotations. No or limited training was blamed on the lack of national guidelines in cardio-oncology and lack of funding by 44% of programs surveyed.

But the need is there. A significant number of those surveyed reported they did not feel confident in dealing with cardiovascular care specific to patients with cancer and gave themselves only an average rating when asked about their level of understanding of the impact of holding or stopping cancer treatments on patient outcomes.

Cardiologists similarly rated their oncology peers, giving them an average rating on their understanding of the impact of slow or inadequate cardiology assessment in the development of cardiovascular complications in patients with cancer.

"Despite the common belief that cancer patients with treatment-related cardiovascular issues would greatly benefit from a specialized team devoted to the cardio-oncology field and a significant number of cancer patients experiencing treatment-related cardiovascular issues, we are lacking the proper resources to care for these patients," said lead author Ana Barac, MD, PhD, director of the cardio-oncology program at MedStar Heart and Vascular Institute in Washington, DC.

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