Moudgil, Rohit

The long-term survivorship of patients diagnosed with cancer has improved due to accelerated detection and rapidly evolving cancer treatment strategies. As such, the evaluation and management of cancer therapy related complications has become increasingly important, including cardiovascular complications. These have been captured under the umbrella term “cardiotoxicity” and include left ventricular dysfunction and heart failure, acute coronary syndromes, valvular abnormalities, pericardial disease, arrhythmia, myocarditis, and vascular complications. These complications add to the burden of cardiovascular disease (CVD) or are risk factors patients with cancer treatment are presenting with. Of note, both pre- and newly developing CVD is of prognostic significance, not only from a cardiovascular perspective but also overall, potentially impacting the level of cancer therapy that is possible. Currently, there are varying recommendations and practices regarding CVD risk assessment and mitigating strategies throughout the cancer continuum. This article provides an overview on this topic, in particular, the role of cardiac imaging in the care of the patient with cancer. Furthermore, it summarizes the current evidence on the spectrum, prevention, and management of chemotherapy-related adverse cardiac effects.

BACKGROUND: Global collaboration in cardio-oncology is needed to understand the prevalence of cancer therapy-related cardiovascular toxicity in different risk groups, practice settings, and geographic locations. There are limited data on the socioeconomic and racial/ethnic disparities that may impact access to care and outcomes. To address these gaps, we established the Global Cardio-Oncology Registry, a multinational, multicenter prospective registry. METHODS: We assembled cardiologists and oncologists from academic and community settings to collaborate in the first Global Cardio-Oncology Registry. Subsequently, a survey for site resources, demographics, and intention to participate was conducted. We designed an online data platform to facilitate this global initiative. RESULTS: A total of 119 sites responded to an online questionnaire on their practices and main goals of the registry: 49 US sites from 23 states and 70 international sites from 5 continents indicated a willingness to participate in the Global Cardio-Oncology Registry. Sites were more commonly led by cardiologists (85/119; 72%) and were more often university/teaching (81/119; 68%) than community based (38/119; 32%). The average number of cardio-oncology patients treated per month was 80 per site. The top 3 Global Cardio-Oncology Registry priorities in cardio-oncology care were breast cancer, hematologic malignancies, and patients treated with immune checkpoint inhibitors. Executive and scientific committees and specific committees were established. A pilot phase for breast cancer using Research Electronic Data Capture Cloud platform recently started patient enrollment. CONCLUSIONS: We present the structure for a global collaboration. Information derived from the Global Cardio-Oncology Registry will help understand the risk factors impacting cancer therapy-related cardiovascular toxicity in different geographic locations and therefore contribute to reduce access gaps in cardio-oncology care. Risk calculators will be prospectively derived and validated.

Introduction: Global collaboration in cardio-oncology (CO) is needed to understand the prevalence of cancer treatment related cardiovascular disease (CTRCD) in different risk groups, practice settings and geographic locations. Furthermore, socio-economic and ethnic disparities may impact access to care. Methods: We assembled cardiologists (CA) and oncologists from academic and community settings to collaborate in the first global cardio-oncology registry (G-COR). US and international CO physicians participated in the first global virtual meeting to assess feasibility and structure for G-COR. Subsequently, a survey for sites resources, demographics and intention to participate was conducted. Results: Responses with sites demographics from 104/140 sites invited: 43 US sites from 23 states and 61 international sites from 5 continents indicated decision to participate in G-COR. Sites were more commonly led by CA (74/99) than CA and oncologists (25/99) and were more often University/teaching (68/101) than community based (33/101). Significant minorities/disadvantaged CO patient population were reported by 32/43 US sites versus 16/60 international sites. Average number CO patients treated per month was 83, range (5-1,000). Breast cancer was the first or second G-COR priority for 84 centers, hematological malignancies (HEM) for 66 centers, and immune check point inhibitors (ICI) for 36 centers. Echocardiography with strain imaging is available in 92/95 participating sites and cardiac MRI in 80/86 sites. Biomarkers are used only in suspected or confirmed CTRCD in 56/96 sites and for risk stratification in high risk patients in 40/96 sites. Subsequently, scientific committee and topic committees for breast cancer, HEM, ICI, and disparities in CO were established. A pilot phase utilizing a RedCap Cloud platform will start enrolling patients in the last quarter of 2021 and the registry for all main pillars will launch in early 2022. Conclusions: We present a global initiative for conducting collaborative research. Information learned G-COR will help understanding risk factors impacting CTRCD in different geographic locations and therefore help reducing access gaps in CO care. Additionally, mitigating strategies can be devised for the future.

Abstract BackgroundRe-allocation of resources during the COVID-19 pandemic has resulted in delays in care delivery to patients with cardiovascular disease and cancer. The ability of health care providers to provide optimal care in this setting has not been formally evaluated.ObjectivesTo assess the impact of COVID-19 resource re-allocation on scheduling, testing, elective procedures, telemedicine access, use of new COVID-19 therapies, and providers’ opinions on healthcare policies among oncology and cardiology practitioners.MethodsAn electronic survey was conducted by a cardio-oncology collaborative network through regional and state chapters of the American College of Cardiology , American Society of Clinical Oncology, and the International Cardio-Oncology Society. Descriptive statistics were reported by frequency and proportion for analyses, and stratified categorically by geographic region and specialty.Results1,415 providers (43 countries) participated: 986 cardiologists, 306 oncologists, and 118 trainees/internal medicine. 63% (195/306) of oncologists vs 92% (896/976) of cardiologists reported cancellations of treatments/elective procedures (p=0.01). 46% (442/970) of cardiologists and 25% (76/303) of oncologists modified the scope of their practice (p=<0.001). Academic physicians (74.5%) felt better supplied with personal protective equipment (PPE) vs non-academic (74.5% vs 67.2%; p=0.018). Telemedicine was less common in Europe 81% (74/91), and Latin America 64% (101/158), than the United States, 88% (950/1,097) (p=<0.001). 95% of all groups supported more active leadership from medical professional societies.ConclusionsThese results support initiatives to promote expanded coverage for telemedicine, increased access to PPE, better testing availability and involvement of medical professional societies to help with preparedness for future health care crisis.Appendix: Link to the Survey: https://www.surveymonkey.com/r/C8ZDYNW