Is lack of ‘narrative’ holding back cardio-oncology?

Risk Factors

By Geir O'Rourke

8 Jul 2024

While the broad spectrum of issues at the nexus of cardiac and cancer care indicate there is real patient need for cardio-oncology, these same factors may also be holding it back as a sub-specialty, it is being argued.

That is the case being made by cardiologist Professor Aaron Sverdlov and colleagues in a new paper urging an ‘actionable narrative’ for the sub-specialty, aimed particularly at educating and upskilling colleagues.

Arguably the list of cardio-oncology risk factors is larger than those for either discipline alone but although the risk factors overlap, they do not fully converge, note the authors, who also include Peter Mac’s Dr Mark Nolan and Professor Doan Ngo of the University of Newcastle .

“Whereas our interventional cardiology colleagues predominantly focus on treatments of atherosclerotic disease and our electrophysiology colleagues predominantly focus on preventing and/or treating arrhythmias, the cardio-oncologist must focus on a constellation of cardiovascular conditions associated with an ever-increasing range of anti-cancer agents for a formidable number of malignancies,” they wrote in Trends in Cardiovascular Medicine (link here).

Professor Aaron Sverdlov

“The diligent cardio-oncologist can expect to find oneself regularly managing cardiomyopathies, arrhythmias, coronary disease, valvular disease, pericardial disease and must still be familiar with preventative cardiology to reduce downstream risk of these conditions emerging.”

By way of example, the authors pointed out that the European Society of Cardiology’s (ESC) cardio-oncology guidelines covered 18 classes of anti-cancer treatments with complications covering the full cardiovascular spectrum. As a result, this document was fully 39% longer than the ESC’s revascularisation guidelines, they said.

“This leads to a question that cardio-oncologists strive to answer when using the traditional format of seminar or narrative review to share our experience and knowledge; how can we clinicians systematically educate and upskill our colleagues about such a diverse and sprawling field within such limited space?”

The authors offered a few suggestions, noting narrative reviews had been published on the subject, providing a good starting point.

Nevertheless, there was work to be done to convert these into a single actionable plan or vision for clinical improvement, they said.

Beyond that, practical guidance was often needed to assist centres in establishing cardio-oncology services, such as the roadmap recently published by the Australian Cardiovascular Alliance.

“Setting up novel clinical services is always an unappreciated challenge with many cultural, recruiting and funding obstacles to be overcome,” they wrote.

“The need for such services appears evident, as less than two-thirds of cancer-therapy-related cardiovascular disease patients receive appropriate care in some centres and thus there are likely significant potential benefits to setting up an institutional cardio-oncology service.”

The authors concluded: “Clinical research requires adaptation and development of infrastructure in order to translate into healthcare gains and this is a process that we can and should all participate in.”

“All developments and practice improvements in medicine ultimately start with good research and the field of cardio-oncology requires more high-quality research to develop new and more comprehensive guidelines and to assist in implementing these guidelines at both the institutional and personal level.”

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