'Roadmap' for success: How to build a successful cardio-oncology program
Novel therapeutics have led to significant survival improvements for many cancers.
However, many of these treatments have been linked to cardiovascular adverse effects that can contribute to morbidity or mortality.
Consequently, it has become increasingly important for cancer centers to offer cardio-oncology care to ensure optimal outcomes for patients undergoing cancer treatment, as well as cancer survivors.
A paper in JACC: CardioOncology outlined the steps for developing a successful cardio-oncology program.
“Cardio-oncology is a collaborative, multidisciplinary field aimed at managing cardiovascular disease and cardiovascular risk [among] both patients who are receiving cancer treatment and cancer survivors,” co-author Michael G. Fradley, MD, medical director of University of Pennsylvania's Thalheimer Center for Cardio-Oncology and section chief of consultative cardiology at Hospital of the University of Pennsylvania, told Healio. “The goal is to ensure that cardiovascular disease doesn’t become a barrier to a patient receiving optimal cancer therapy, nor do we want a patient to survive their cancer only to be left with a lifelong, debilitating cardiovascular disease.”
Fradley spoke with Healio about the importance of establishing programs that take a holistic approach to patients during cancer treatment and survivorship.
Healio: What inspired you to outline this approach to creating a cardio-oncology program?
Fradley: Cardio-oncology programs are really important for patient care. We work as a team to ensure the patients are getting the right treatments for their cancer, while also carefully monitoring their heart.
The goal of this paper was to provide a roadmap for individuals who are interested in developing cardio-oncology programs. We wanted to create something that was simplistic, easy to follow and translatable regardless of practice location. Whether the person is in a traditional academic center or a community-based practice, we wanted them to be able to take the recommendations in this manuscript and apply them to their own unique settings. We wanted to highlight key principles that are universal in developing these programs.
Healio: What are the building blocks you mention for developing a cardio-oncology program?
Fradley: The first building block involves developing a clear mission and vision. This is very important for any novel program, whether it’s cardio-oncology or something else. It’s important to have a sense of where you are and where you want to go. Defining these goals explicitly is important. Once you understand the current landscape and your ultimate plans and goals, you can more easily mold and create a program that has potential to be successful.
Our second building block is to foster partnerships. Cardio-oncology is a very collaborative, multidisciplinary specialty. Early in the development of a cardio-oncology program, you want to make sure that there are strong relationships between both cardiologists and oncologists. Both specialties must be actively engaged and involved in program development for it to be successful.
Building these relationships can be accomplished through various mechanisms; however, it really is an active process — an individual who wants to develop a program has to make a concerted effort to engage and create these relationships.
The next building block is to recruit high-quality clinicians and allied health professionals. That piggybacks on the idea of collaborative, patient-centered care. You want to make sure your program has a sufficient number of providers to care for these patients, with the right set of knowledge and expertise. We want cardiologists who understand oncology care, and oncologists who recognize the value and need for cardiovascular surveillance.
We want to also make sure that we utilize our nonphysician partners, who can be incredibly important in a collaborative practice, including nurses, pharmacists and advanced practice providers.
The next building block is education and research. Incorporating education and research into a program is important. It doesn’t have to be in the traditional sense — we tend to think of research as occurring in an academic environment. However, individuals in any location can participate in registries and educating other members of the community about the importance of this field. That’s a way to ensure we are giving back to the greater good of cardio-oncology.
Finally, we recommend patience. Whenever people start a program, there’s a lot of excitement and desire to have a quick return on investment. Ultimately, though, it’s not a sprint — it’s a marathon. People have to be patient as they build their program. The patients ultimately will come — there is a great need for cardio-oncology. However, it’s going to take time to build a network and a clinical operation.
Healio: Is there anything else you’d like to mention?
Fradley: It’s important to demonstrate value to your organization, and value can be defined in multiple different ways. Financial value is something that a lot of organizations and health care systems are going to be paying attention to, and it’s going to be important to partner with administrators to help them understand where the value and the return on investment comes from. Ultimately, though, I think because there is such a large number of [patients with cancer] and an explosive number of cancer survivors, this is the type of program that can be incredibly busy and incredibly successful, with the right set of resources and motivated individuals.
For more information:
Michael G. Fradley, MD, can be reached at Perelman Center for Advanced Medicine, 3400 Civic Center Blvd. 2-355 PCAM, Philadelphia. PA 19104; email: michael.fradley@pennmedicine.upenn.edu.
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