Establishing an oncocardiology service
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L. H. Lehmann1,2,3 · M. Totzeck4 1
Department of Cardiology, Angiology, Pneumology, Cardio-Oncology Unit, Heidelberg University Hospital, Heidelberg, Germany 2 DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany 3 4
Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Medical Faculty, University of Duisburg-Essen, Essen, Germany
Establishing an oncocardiology service The heart matters Advances in cancer treatment and “personalized therapy” strategies have improved the survival of many cancer patients. As a consequence, cancer comorbidities such as cardiac disease are of growing importance for cancer patients. Moreover, cardiac pathologies are reported to play a more relevant role in morbidity and mortality of several conditions than the underlying malignant disease itself [1–3]. In addition to common risk factors for cardiac disease and cancer, the direct effects of tumors and their therapies can lead to cardiac pathologies. To reduce mortality and morbidity and to improve patient care, it will be essential to establish a network of oncocardiology services that allows us to enhance cardiac surveillance strategies and to improve adherence to cardiological diagnostics and therapy. Registries as well as clinical and basic research should form the basis for further evidence-based strategies. However, the patient-centered integration of all layers of an oncocardiology service is a challenge (. Fig. 1).
lished follow-up strategies. For example, patients with breast cancer and presumed long-term survival will require a different setting than patients with hematological diseases who will undergo transplantation in the near future or patients with gastroesophageal cancers with neoadjuvant therapies followed by surgical intervention. Starting with a circumscribed patient cohort simplifies the creation of an oncocardiology service. The European Society of Cardiology (ESC) distinguishes between an oncocardiology service that is applicable to general/district hospitals, tertiary hospitals, or selected centers [4]. The main difference is the number and diversity of patients who are potentially admitted to the service. In university or large nonacademic hospitals, the number of patients who potentially need oncocardiological assessment is high. Therefore, a telephonebased consultation service might be helpful for the pre-assessment of patients (. Fig. 2).
Who needs an oncocardiology service?
Local requirements Establishing an oncocardiology service depends on the local requirements. It is crucial to identify the patients who will potentially benefit from this service. However, the oncocardiology service needs to be adapted to already-estab-
Besides the “classic” cardiotoxic cancer drugs, such as anthracyclines or HER2 antibodies, there is a growing number of novel classes of therapeutics. Among these novel therapies, immune checkpoint inhibitors, proteasome
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