Specialised cardio-oncology clinics prove popular with patients

Patients appear to be embracing the option of specialised cardio-oncology clinics, with many reporting they appreciate having their cardiovascular disease ‘remembered’ during cancer treatment.

It comes as services combining cardiologists and oncologists spring up around Australia in response to concerns about treatment-induced cardiotoxicity – that can see patients survive cancer only to develop serious cardiovascular morbidity and mortality.

Researchers conducted in-depth interviews with 15 patients attending a recently-established unit at Newcastle’s Calvary Mater Hospital, which has been operating weekly cardio-oncology outpatient clinics since 2018.

The patients, aged 38–74 years and all with at least one baseline cardiovascular risk factor, were unanimous in saying they appreciated the integrated service, which provided access to consultant cardiologists as well as an experienced cardio-oncology nurse.

Benefits included early intervention and access to information, with most interviewees saying they had been unaware of the associations between cardiovascular disease and cancer treatment before attending the clinic, the researchers reported.

And all participants said that being referred early provided a sense of “relief and comfort, rather than exemplifying any health concerns,” they wrote in Cardio-Oncology (link).

“Following CVD changes, all participants appreciated regular monitoring and ongoing management of CVD symptoms.”

“Further, the responsiveness of the cardio oncology clinic and recommendations provided made them feel cared for. Being treated with a calming and reassuring manner helped to reduce any apprehension about their health.”

Comments from oncology patients highlighted the reassurance they felt from early referral to a cardio-oncology clinic.

I developed cardiomyopathy. I have 46% heart function at the moment, so it’s dropped. The chemotherapy has knocked it around a bit, but [the cardiologist] has got me on medication and monitoring me every three months or so. So far, everything is going okay,” said one.

Another positive was the collaboration between oncologists and cardiologists, which enabled coordinated care and “feelings of personalised care”, the authors said.

One patient commented: “I feel comfortable. [The cardiologist] has been an assurance that …. neither [specialist] was sort of guessing something out of their field. They are both excellent, you know. On occasions the oncologist might say in discussion, “Oh that’s the cardiologist [problem]” or [the cardiologist] will say, “Go talk to [the oncologist about that].”…. I talk to both of them.”

The researchers said cancer patients referred to the clinic felt valued as a person, such as being given choice in decision making and not having to having repeat their experience to multiple clinicians.

“A pleasing finding of this research was that patients felt their needs were included in multidisciplinary discussions and in response this promoted feelings of confidence in treating professionals and the care they received.”

Nevertheless, there was still a way to go, with most participants admitting to struggling with lifestyle changes to address their CVD risk factors, particularly during cancer treatment.

“Early intervention was shown to mitigate CVD and associated complications while also ensuring the continuity of cancer treatment, but more support is needed to address CVD risk factors such as access to chronic disease management programs,” they added.

For most patients, overcoming cancer was the priority, the comments suggested.

“It’s really hard to find that balance, because if my heart function drops then I miss out on treatment,” said one patient.

“It is sort of scary to not have your treatment. It’s a double-edged sword, because my cancer is sort of stable, but my heart isn’t, so, you just can’t win. It would be good if it all just came together and you know, if it is not one thing it’s another, but yeah, finding a balance… I haven’t found it yet. It’s really really hard. But they keep you stable, that is fantastic.”

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