You've Got to Have Heart: Creating a Cardio-Oncology Program in the Community

As American Heart Month draws to a close, ACCCBuzz shares a post describing how an ACCC member program brought service lines together to create an outpatient cardio-oncology program. This post is adapted from “Development of an Outpatient Cardio-Oncology Program,” an article by Laurie Walton Fitzgerald, MSN, RN, and Peyton Neilson, MSN, RN, OCN, that first appeared in ACCC's journal, Oncology Issues (May/June 2018).

As the number of cancer patients and survivors continues to rise nationwide, the prevalence of cardiovascular disease in patients who have received cancer therapies is also increasing. Because cardiotoxicity as a side effect of cancer treatments is often indicated by the signs and symptoms of congestive heart failure, patients can benefit greatly by having their cardiac health closely monitored both during and after treatment.

Although most dedicated cardio-oncology programs are housed in academic cancer centers, the majority of cancer patients are treated in community cancer programs, making it vital that these multidisciplinary programs regularly monitor and address cardiotoxicity in their patient populations. 

Recognizing this need, in 2016, University of Maryland Upper Chesapeake Health, the Heart and Vascular Institute, and the Kaufman Cancer Center joined forces to create a cardio-oncology program. The scope of cardio-oncology includes the prevention, detection, monitoring, and treatment of cardiovascular toxicity before, during, and at the end of anti-cancer treatment. To cultivate these capabilities, the program’s planning team:

• Reviewed current gaps and prioritized services by conducting a needs assessment, educating clinical staff, and scheduling timely cardiology consultations and echocardiograms.

   

• Identified the population most at risk for cardiotoxicity and developed referral and follow-up criteria to ensure appropriate patients are connected to cardiologists.

   

• Conducted a detailed review of chemotherapeutic agents and cardiotoxicity indications to identify the agents that have the highest risk for cardiotoxicity (e.g., chemotherapeutics, biologics, and immunotherapies).

   

• Conducted baseline monitoring, identified those at risk for developing cardiotoxicity, and developed monitoring guidelines and a patient assessment form.

   

• Developed risk stratification models of clinical pathways and created cardio-oncology guidelines for before, during, and after treatment.

   

• Established general practice guidelines for the community cancer center, streamlined the scheduling and referral process, and educated clinical staff on the appropriate use of guidelines.

The planning team reviewed treatment regimens and narrowed the program’s focus to the top cardio-toxic agents administered in Kaufman Cancer Center. Patients receiving those regimens are designated as “high risk.” An assessment tool for at-risk patients helps providers predict and monitor cardiotoxicity, individualize treatment plans, and conduct interval cardiac follow-up and management.

Clinicians recommend high-risk patients for consultation with the cardio-oncology program. The referral decision takes into consideration patient history, lifestyle, risk factors, and previous cardiac evaluations.

Once identified as high risk, patients receive a card that informs them their oncologist has prescribed a treatment plan that may affect their heart health. This card briefly explains the cardio-oncology program, introduces patients to the program’s cardiologists, and explains what to expect at their cardiac visit. The oncology nurse navigator provides additional patient education and helps patients schedule an appointment prior to starting their chemotherapy regimen. When patients conclude their anticancer treatments, nurses give them individualized survivorship care plans that take into account their heart health.

The Kaufman Cancer Center credits the program with helping improve care coordination, collaboration, quality of care, education, cost-effectiveness, and communication between oncology and cardiology specialists. Most important, clinicians have seen an increase in the early management of patients experiencing cardiac side effects from their treatment.

Read more on how the program was developed here.