click to edit master title style developing a cardiac oncology fellowship program asco june 2014...

Click to edit Master title style

Developing a Cardiac Oncology Fellowship ProgramASCO June 2014

Susan DentMedical OncologistThe Ottawa Hospital Cancer CenterOttawa, Canada


101112131415161718 Cancer Survivors (Million) 2012 - 2018

The problem

Click to edit Master title styleCancer Survivors (Million) 2012 - 2018

00.20.40.60.8

11.21.41.61.8

2


Brigham, MGH

MSK

U Penn

Medstar Washington

Louisville

Duke

Vanderbilt

MD Anderson

Stanford

Click to edit Master title style Why do we need Cardiac Oncologists?• N = 63 with LVSD (LVEF < / = 45%) post chemo • 67% symptomatic HF: 54% had Cardiology input (black) • Survival 71% vs 41% in no Cardiology input

Cardiovascular Management of Cancer Patients With Chemotherapy-Associated Left Ventricular Systolic

Dysfunction in Real-World Clinical PracticeJournal of Cardiac Failure, Volume 19, Issue 9,

2013, 629 - 634

Cardiology input = black

No Cardiology = white

All = grey


Yoon , Telli , Kao , Matsuda , Carlson , Witteles

Left Ventricular Dysfunction in Patients Receiving Cardiotoxic Cancer Therapies : Are Clinicians Responding Optimally?

Journal of the American College of Cardiology, Volume 56, Issue 20, 2010, 1644 - 1650

Why do we need cardiac oncologists ?

Click to edit Master title styleWhat is Needed !

Network / Collaboration

• Facilitate networking: ICOS NA , CCON

• Create WG and TFs – link

• Publicize Cardio-Oncology: websites, social media

• Facilitate Research Collaborations: invite participation – group efforts

Clinical

• Centralize existing resources, create white papers and guidelines

• Create a learning pathway

Training

• Develop a Fellowship program

• Standardized Curriculum

Click to edit Master title style Fellowship Training – what’s out there

• 7 Fellows in US / Canada

• No accreditation

• No internal funding

• No recognized structure to follow


Cardiac Oncologist?

HF Imaging Research

Consults Clinics

Cardiology Oncology


Should we develop a curriculum for cardiac oncology ?


GOALS OF THE CURRICULUM

Convey a knowledge base. Stimulate research.

Integrate into mainstream cardiology and oncology training programs

Reshape the mindset about traditional roles of cardiologists and oncologists .

Graduates expand best practices outside the cloistered “cardio oncology centers”, improve practice, lessen disparities in practice.

Richard M. Steingart MDChief, Cardiology Service Memorial Sloan-Kettering Cancer Center


use of chemotherapeutic drugs, biologic products, and growth factors; their mechanisms of action, pharmacokinetics, clinical indications, and

limitations, including their effects, toxicity, and interactions

cardiac tumors


• basic knowledge of cancer agents and their potential to cause cardiac damage

• Imaging strategies – basic knowledge on cardiac imaging in oncology patients

• Basic understanding of treatment strategies for cancer patients experiencing cardiac toxicities

Level 1 (Internal Medicine Residents)

Click to edit Master title style• For residents who wish to broaden their

exposure to cardiac oncology patients• More detailed assessment of patients• Intermediate knowledge base• More exposure to advanced cardiac imaging

eg. advanced echocardiography (strain/3D)• Understanding of the role of biomarkers in

early detection of cardiac toxicity

Level 2 (Medical/Cardiology Resident)

Click to edit Master title style• 12-24 months of dedicated fellowship

training• advanced knowledge of cancer agents and

potential toxicities • broad exposure to in- and out- patients• training in biomarkers, advanced imaging• actively involved in research

Level 3 (Cardiac Oncology Fellow)

Click to edit Master title style• Cardiologist stream• Principles of oncology care• Advanced knowledge of cancer

agents and potential toxicities• Training in biomarkers, advanced

cardiac imaging• Appropriate cardiac imaging

techniques • cardiotoxicity surveillance-

when/how long?• Evidence based treatment with

cardioprotective drugs• Actively involved in research

• Oncologist stream• Understanding cardiac imaging:

limitations and common techniques• Familiarity with principles of heart

failure, arrhythmias and hypertension

• Familiarity with principles of echocardiography , cardiac MRI and biomarkers

• Techniques of cardiac surveillance• Evidence based treatment with

cardioprotective drugs• Actively involved in research

Level 3 Cardiac Oncology Fellow (12-24 months)

Click to edit Master title styleHOW TO ACCOMPLISH THE ESSENTIAL INSTRUCTION?

Cancer therapies taught by cardiologists to cardiology traineesas life saving interventions with manageable toxicity.

Longitudinal Outpatient Cardio-Oncology Clinic• Adults currently receiving anthracyclines/trastuzumab.

– Continuum of benefit and risk.

• Surgical clearance of the cancer patient.• Childhood cancer survivors.• Adults receiving VSPI.

– Blood pressure, CHF and ischemia management.

Inpatient Consultation Service• Antiplatelet/anticoagulant risks and benefits.

click to edit master title style developing a cardiac oncology fellowship program asco june 2014...

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