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Disclosures
• No relevant financial disclosures
Outline: Integration of Cardio-Oncology - from
Cardiology Perspective
• Evidence to support the need for Cardio-Oncology integration
• Building de novo Cardio-Oncology program
• UofL recipe for Cardio-Oncology integration and future plans
Cardiac Risk Factors are Not Rare In Cancer Patients
PACE in Breast Cancer
Median / Percentage N=78
Age 49.5
Race
White 89.7%
African American 9.0%
Pacific Islander 1.2%
Hispanic 2.6%
Geisberg Lenneman J. Cardiac Failure 2013
PACE: Maximal Change in EF During Follow-up
N = 70
15 drop EF below > 10 units
15:70 = 21.4%
Mean change -5.1 units
Geisberg Lenneman J. Cardiac Failure 2013
Fig. 1 Percentage of patients who received ACEI or ARB, betablockers, combination of ACEI or ARB and betablocker, aldosteron antagonists and diuretics after diagnosis of chemotherapy-induced LVSD. Grey bars represent all patients. Black bars represent pati...
Michael Ammon , et al. Journal of Cardiac Failure 2013 629 - 634
Cardiology consultation in setting of chemotherapy induced LVSD improves rates of guideline based HF therapy.
N=61, mean LVEF 34%
52%
100%
41%
94% Improved Survival 71% vs. 41%
Survey of CV Outcomes from Oncology Patients During Survivorship (SCOOP)
• National survey sent out through ResearchMatch.org and CUREtoday.org
• Goal was to assess prevalence of CV disease, CV side effects, lifestyle habits, and CV screening / counseling in cancer survivors.
• 213 responses mean age 56 yo
• 15% reported cardiac history prior to cancer treatment
• 80% would have liked “heart healthy counseling – about exercise, weight / stress management”
• 90% of cancer survivors had not heard of cardio-oncology programs
N Bhatia, C Lenneman KY ACC 2013
SCOOP During Survivorship
N Bhatia, C Lenneman KY ACC 2013
SCOOP During Survivorship
N Bhatia, C Lenneman KY ACC 2013
SCOOP During Survivorship
N Bhatia, C Lenneman KY ACC 2013
Background on Kentucky
• Bluegrass state
– Home of horse racing, bourbon, Louisville Slugger bats
• But its…
– Headquarters of fast food Yum Brands & Tobacco
Hot bed of heart disease
Need for Cardio-Oncology
Over 30 Oncology Groups, Cancer Clinics / Centers 60 miles from Louisville
Growth of Cardio-Oncology Clinic at UofL
0
10
20
30
40
50
60
70
Fall / Winter 2012-13 Spring 2013 Summer 2013
# C
ard
io-O
nc
Pts
Se
en
in C
linic
13
32
66
Echo 134 MUGAs 12 CMRI 2
Downstream Revenue
70% BCA 20% Lymphoma / leukemia 10% Lung CA
UofL Recipe for Cardio-Oncology Integrative Care
• Team Building – Tumor Board
• Started collaborative clinical research projects / protocols
Monitoring Algorithm for Cardiotoxicity
in Ac-based Chemotherapy
Cycle 1 Cycle 2 Cycle 3 Cycle 4
EKG Tp/BNP Tp/BNP Tp/BNP
Tp / BNP if wnl proceed if wnl proceed if wnl proceed
Echo with Strain if abnl check Echo if abnl check Echo if abnl check Echo
Consider BB / ACE Consider BB / ACE Consider BB / ACE
Continue Chemo if LVEF >50% Continue Chemo if LVEF >50% Continue Chemo if LVEF >50%
If LVEF < 50% BB/ACE and repeat
Echo in 3-4 wks If LVEF < 50% BB/ACE and repeat Echo
in 3-4 wks If LVEF < 50% BB/ACE and repeat Echo
in 3-4 wks
*** *** ***
*** If LVEF falls below 40% consider stopping / changing regimen / cardio-oncology collaborative meeting
Modified from other cardio-oncology programs
UofL Recipe for Cardio-Oncology Integrative Care
• Team Building – Tumor Board
• Started collaborative clinical research projects / protocols
• Communication – Cell Phone / email
– Electronic medical record
– Facilitate necessary cardiac work-up
• Built translational working group – Adult / pediatric oncologist & cardiologists, basic
science tumor biologist / CV physiologist
Future Plans UofL Cardio-Oncology Program
• Engage the surgical & radiation oncologist
• Hired a physical medicine rehabilitation physician – specializes in rehabilitation and exercise Rx for oncology patients
• Added nutritionist and mental health counselor to help address unmet needs in cancer survivors
Special thanks!!!
Women who participate in cancer research
Collaborators: Oncologist at Vanderbilt & Brown Cancer Center
Mentors: Doug Sawyer & Dan Lenihan & Cardio-Onc Translational Group
Fellows: Wissam Abdallah, Bitar Abbas RN: Darla Freehardt, Brenda White
Resident: Nirman Bhatia
Questions?
Cardio-Oncology at VA & UofL Hospital
VA clinic 6 months 38 pts 50% BCA
30% Lung CA
10% H&N
10% Testicular
1 mo consults ULH 12 consults 33% + Tp (mets to heart) 8% Pericardial effusion 16% NSTEMI 25% afib 8% HF
Field of Dreams
If you build it…
They will come