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