Duke Health’s fast-growing cardio-oncology program continues its expansion with the goal of becoming one of the largest academic medical practices of its kind in the Carolinas.
A collaborative specialty that evolved as a response to cardiovascular complications from conventional and emerging cancer treatments, cardio-oncology has expanded across many presentations, including hematologic malignancies as well as breast, genitourinary, and gastrointestinal solid tumors. Individuals undergoing stem cell replacement who seek cardio-oncology assessment of cardiovascular health before transplant represent an increasing number of patients.
Cardio-oncologists encourage referrals before a patient begins cancer treatment so they can recommend proactive therapies to avoid heart-related complications that may interrupt life-saving cancer therapy. Specialists review preexisting cardiovascular risk factors such as diabetes, hypertension, and arrythmias to determine if cancer treatments will exacerbate existing conditions or introduce new complications such as heart failure, thromboembolism, pericarditis, or ischemic heart disease.
Team is expanding
Medical oncologist Susan Faye Dent, MD, and cardiologist Michel G. Khouri, MD, lead the program as co-directors. Two team members joined during the past year: Brandy Patterson, MD, a cardiologist with previous academic cardio-oncology experience, and June Weston, the program’s first staff member. New clinical research has already been launched, offering options to patients. And long-term, leaders want to create a cardio-oncology fellowship.
“We’ve reached the end of the beginning,” says Khouri, referring to the state of the program. Khouri helped launch the initiative when he joined Duke in 2012; most of the early growth has been a result of grassroots outreach to referring physicians. Khouri has also created a novel cardiovascular risk stratification tool embedded in the EHR to help oncologists assess patient risk.
“To achieve our full potential, this commitment to protect the heart and cardiovascular system must be woven into the fabric of both cardiology and oncology,” Khouri says. “Many patients we see after cancer treatments would have benefitted from at least one consult with a cardiologist before treatment.”
- Identifying Cardio-Oncology Needs of Cancer Patients: Despite the growth of cardio-oncology clinics, physicians’ understanding of patient demographics within the referral population is limited. This retrospective cohort study will determine the number of Duke cancer patients requiring cardio-oncology care based on cancer diagnoses and therapy received.
- Cardiovascular Risk Stratification in Breast Cancer Patients Receiving Cancer Therapy: A pilot study will analyze the effectiveness of a risk stratification software tool by analyzing utilization by health care providers as well as effects on patient referral patterns and patient outcomes, via data extracted from the electronic health record.
- Cardiovascular Risk Profile and Treatment Patterns in ER+HER2-Advanced Breast Cancer: A retrospective cohort study seeks to describe patient characteristics and treatment patterns for patients with ER+/HER2-advanced breast cancer treated with endocrine therapy or ET + CDK4/6 inhibitor.
Origins of cardio-oncology at Duke
Dent joined Duke in 2018 after pioneering national cardiovascular and oncology collaborations in Canada, notably the Canadian Cardiac Oncology Network. She also created the Global Cardio-Oncology Summit, an annual research-focused symposium bringing together specialists ranging from basic scientists to nurses to pharmacists.
“Originally this field focused on breast cancer because anthracyclines commonly used to treat breast cancers resulted in cardiotoxicity,” says Dent. “Women treated for breast cancer would show up in cardiology clinics years later with heart failure symptoms.
“That’s what lead to my interest in the cardio-oncology specialty. Dealing with these challenges contributed to improved patient education about breast cancer therapies.”
Evolving cancer therapies, a place of hope
Cancer treatments have evolved dramatically, Dent says, noting that targeted drugs now offer more precise therapies for specific cancers. She notes, however, these novel drugs present new challenges in terms of cardiovascular toxicities such as hypertension associated with sunitinib.
“In 2021 it is no longer acceptable to simply inform cancer patients that they will be treated with six cycles of chemotherapy,” Dent says. “We now need to consider the impact these therapies will have on their cardiovascular health--not just today, but five to 15 years down the road.”
Patterson, recruited from a growing cardio-oncology program at the University of Virginia Health System, says the Duke program has enormous potential to improve patient care and disease management.
“After being here just a few months, it’s clear that Duke is a place of hope where anything and everything is possible,” she says. “What makes this program remarkable is that you have a team of Cardiologists and Hematologist/Oncologists with clinical, research and educational excellence in cardio-oncology which will ultimately improve patient care and disease management. This program represents the future of collaborative cardio-oncology care.”