Premium
Activity and outcomes of a cardio‐oncology service in the United Kingdom—a five‐year experience
Author(s) -
Pareek Nilesh,
Cevallos Joaquim,
Moliner Pedro,
Shah Mit,
Tan Li Ling,
Chambers Vicki,
Baksi A. John,
Khattar Rajdeep S.,
Sharma Rakesh,
Rosen Stuart D.,
Lyon Alexander R.
Publication year - 2018
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1292
Subject(s) - medicine , ejection fraction , cardiotoxicity , heart failure , cardiology , cancer , chemotherapy , radiation therapy , oncology
Aims Cardio‐oncology clinics optimise the cardiovascular status of cancer patients but there is a limited description of their structure, case mix, activity and results. The purpose of this paper is to describe the activity and outcomes of a cardio‐oncology service, particularly with respect to supporting optimal cancer treatment and survival. Methods and results We prospectively studied patients referred to our service from February 2011 to February 2016. New York Heart Association (NYHA) class and parameters of cardiac function were measured at baseline and after optimisation by our service. Up‐titration of cardiac treatment, continuation of cancer therapy and mortality were used as outcome measures. Of the 535 patients (55.8% females) referred, rates of cardiotoxicity for anthracyclines, anti‐HER2 agents and tyrosine kinase inhibitors were 75.8%, 69.8% and 62.1%, respectively. Patients with left ventricular systolic dysfunction (LVSD) ( n =128) were younger, had higher rates of hypertension and previous exposure to chemotherapy/radiotherapy ( P < 0.001). At a median follow‐up of 360 days, 93.8% of the patients with LVSD showed improvement in left ventricular ejection fraction (45% pre vs. 53% post; P < 0.001) and NYHA class (NYHA III–IV in 22% pre vs. 10% post; P = 0.01). All patients with normal left ventricular ejection fraction and biochemical or functional myocardial toxicity and 88% of patients with LVSD were deemed fit for continuation of cancer therapy after cardiovascular optimisation. Conclusions Through the establishment of a cardio‐oncology service, it is feasible to achieve high rates of cardiac optimisation and cancer treatment continuation.