Cardio-oncology is a rapidly growing subspeciality


By David Rowley

2 May 2019

There is a rapidly growing need for ‘cardio-oncology’ specialists to manage patients with cancer and co-morbid cardiovascular disease, according to Professor Leonard Kritharides, president of the Cardiac Society of Australia and New Zealand.

Speaking to the limbic, he said while many clinicians were conscious of the need for more training in cardio-oncology, there is “a lot of work for us to do”.

In the US the number of cardiology centres offering cardio-oncology services has doubled since 2014, and about 50% of cardiovascular training programs now include cardio-oncology topics as part of their core curriculum, according to a review in JACC.

Professor Kritharides said there were many cardio-oncology programs underway in different locations in Australia and some clinicians were already publishing on the topic.

At an individual level, oncologists would discuss patients’ cardiovascular management informally with cardiologists, but the field of biologic therapies was proliferating in a way that required formalisation of such approaches, he said.

And Professor Kritharides, who is Head of Department of Cardiology at Concord Hospital, Sydney, said discussions were already underway with various cancer societies with an eye to developing programs for such a subspecialty.

But ultimately, he said, “we need to find an Australian way to do this”.

The US review, entitled “Preparing the Cardiovascular Workforce to Care for Oncology Patients”, recommends that cardio-oncology be established as “a universally recognised subspecialty of cardiology” similar to those for heart failure, imaging, and preventive cardiology.

“An ageing population with a history of cancer and cardiovascular disease, and an increasingly diverse array of cancer treatments with complex, but incompletely understood, effects on the CV system has led to the need for the development of the discipline of cardio-oncology”, the authors wrote.

A formalised cardio-oncology sub-speciality training curriculum of up to one year should include competencies such as cancer therapy and radiation-induced cardiotoxicity, personalising cancer therapy based on cardiovascular risk and optimising cardiovascular prevention and treatment for oncology patients. Other core components for a cardio-oncology workforce would include basic, translational and clinical research, clinical standards development, advocacy, and development of partnerships with other specialities and with other sectors, the US reviewers suggested.

But Dr Kritharides said he believed the US proposed model of cardio-oncology as a “superspeciality”, may not be the right model for Australia.

“In Australia we tend to be far more generalised in our practices – what we have to do is find…a way to tailor it to our workforce”. But he imagined much of the cardio-oncology workload would be handled “by well-trained cardiologists” in the first instance.

One key step could be for cardiologists and oncologists to be going to the same events, he suggested.

In South Australia, Flinders University Professor of Cardiology Derek Chew is a co-researcher in a two-year study that aims to develop a framework for care “where cardiovascular risk management is embedded into breast cancer care”.

Made possible by a $290,000 grant from the National Breast Cancer Foundation, the project is bringing together specialists in cancer, cardiology and nursing, who will create an integrated care model across cancer and cardiology.

“It is impractical to expect every breast cancer patient to be seen by a cardiologist,” said Professor Chew.

“However cancer specialists are not always skilled in managing risk factors for cardiac disease, and GP may not be aware of the potential for cardiotoxicity caused by cancer treatment,” he noted.

Project Lead Professor Bogda Koczwara, who leads the Cancer Survivorship Research Group at the Flinders Centre for Innovation in Cancer,  said treatment for breast cancer increased the risk of cardiovascular disease, yet no formal clinical pathway for prevention, monitoring and management of this risk exists, leading to care that is often fragmented and variable.

“While guidelines exist for managing cardiovascular disease during cancer treatment, the risk factors not related to cancer are often neglected – meaning strategies to improve heart prospects for cancer survivors can be overlooked.

“Neglecting these represents a missed opportunity for better outcomes in terms of cancer and cardiovascular disease.”

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