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Journal of the American College of Cardiology

Clinical Articles, News & Views

Cardio-oncology services needed to improve patient care

The impact of cancer treatments on cardiovascular health is an important consideration when treating cancer patients, but many hospital training programmes have no formal training or services in cardio-oncology and a lack of national guidelines and funding are frequent barriers to establishing such programmes, according to a nationwide survey published recently in the Journal of the American College of Cardiology.1

The American College of Cardiology 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 programmes and advocate for the specialty.

The ACC Early Career Section conducted a survey in May 2014 of cardiology division chiefs and cardiovascular fellowship programme 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 patient treatment continuum, and 65% thought access to consultants with specialised training would provide an advantage in caring for cancer patients suffering cardiovascular complications.

However, only 35% of centres surveyed included cardio-oncology services in their pre-operative consultation services managed by general cardiology, and only 27% of centres had an established, specialised cardio-oncology service with multiple clinicians. 16% had a single cardiologist with expertise in treating cancer patients, and 12% had no cardio-oncology services but planned to add them within a year.

Almost half of respondents said their programmes offered no formal training in cardio-oncology, with majority of the other half offering exposure during regular rotations. For 44% of programmes surveyed, the reason for no or limited training was both a lack of national guidelines in cardio-oncology and a lack of funding. But the need is there. A significant number of those surveyed reported they did not feel confident in dealing with cardiovascular care specific to cancer patients and gave themselves only an average rating when asked about their level of understanding of the impact of holding or stopping cancer treatments on cancer 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 cancer patients.

“Despite the common belief that cancer patients with treatment related cardiovascular issues would greatly benefit from a specialised 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 Dr Ana Barac, lead author of the study and director of the cardio-oncology programme at MedStar Heart and Vascular Institute in Washington. “A newly formed American College of Cardiology section dedicated to filling this gap will give physicians in the field a forum to discuss best practices and work together to develop methods for training more physicians in providing the best possible care for these unique patients,” Dr Barac added.

References

1. Barac A, Murtagh G, Carver JR et al. Council clinical perspective: cardiovascular health of patients with cancer and cancer survivors: a roadmap to the next level. J Am Coll Cardiol 2015. In press.

Published on: June 26, 2015

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