Poster Presentation Cancer Survivorship 2019

Establishment of a dedicated cardio-oncology service for rapid assessment and management of acute and late cardiovascular conditions (#220)

James Otton 1 2 , Eng-Siew Ko 2 3 4 , Diana Adams 3 5 , Kelly Mok 2 3 , Michael Harvey 2 6 , Silvia Ling 2 6 , Nagendraprasad Sungala 2 6 , Eugene Moylan 3 , Weng Ng 2 3 4 , Gui Xong 3 , Craig Juergens 1 2 , Geoff Delaney 3 4
  1. Department of Cardiology, Liverpool hospital, Sydney, NSW, Australia
  2. UNSW, Sydney, NSW, Australia
  3. Cancer Therapy Centre, Liverpool and Campbelltown Hospitals, Sydney, NSW, Australia
  4. Ingham Institute of Applied Research, Sydney, NSW, Australia
  5. Western Sydney University, Sydney, NSW, Australia
  6. Department of Haematology, Liverpool hospital, Sydney, NSW, Australia

Aims

The field of cardio-oncology is gaining importance due to the rise and range of cancer therapies causing acute and late cardiac toxicity, as well as the need to optimally manage concurrent cardiovascular co-morbidity. We aim to describe the caseload and benefits of a dedicated cardio-oncology clinic (COC) over the first 12 months of operation.

Methods

In October 2017, a cardio-oncology clinic was established and co-located at Liverpool Cancer Therapy Centre staffed by a cardiologist accepting referrals from Oncology and Haematology services in Sydney Southwest Local Health District. The oncology EMR was used as a common data platform. Reason for referral as well as new and follow-up caseload was recorded. Clinico-demographic and oncology treatment for all patients was extracted.

Results

Over a 12 month period, total of 123 (n=86 new and n=37 follow-up) consultations took place. The majority of patients were treated for breast cancer (n=48) followed by colorectal (n=19), lung (n=16), lymphoma (n=14), prostate (n=9), renal and multiple myeloma (n=6). Median time from cancer or haematological diagnosis to COC referral was on average 18 months (range 1-124 months). Therapies with potential cardiotoxic effects included trastuzumab (n=19), 5FU and capecitabine (11), sunitinib (6). Almost half (44%) received radiotherapy. The vast majority of patients were seen within 2 weeks of referral. The most common indications for referral included cardiomyopathy ;  LV dysfunction, chest pain / acute coronary syndrome and palpitations/arrhythmia. Notably, only 5% of referrals pertained to management of late effects post treatment, cardiovascular surveillance or long-term preventative therapies.

Conclusions

A dedicated cardio-oncology service can facilitate more rapid assessment and management of patients with both acute and late cardiovascular toxicities. Future directions include expansion of the service especially to primary care, and incorporation of more comprehensive screening and clinical pathways for at-risk survivor cohorts.